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MEDICAL JURISPRUDENCE 

AND 

TOXICOLOGY 

REESE 



TEXT-BOOK 

OF 

MEDICAL JURISPRUDENCE 

AND 

TOXICOLOGY 



4 
JOHN J. REESE, M.D. 

LATE PROFESSOR OF MEDICAL JURISPRUDENCE AND TOXICOLOGY IN THE UNIVERSITY OF 

PENNSYLVANIA; LATE PRESIDENT OF THE MEDICAL JURISPRUDENCE 

SOCIETY OF PHILADELPHIA 



SEVENTH EDITION 



REVISED BY 



HENRY LEFFMANN, A.M., M.D. 

PROFESSOR OF CHEMISTRY AND TOXICOLOGY IN THE WOMAN'S MEDICAL COLLEGE OF 
PENNSYLVANIA; PATHOLOGICAL CHEMIST TO THE JEFFERSON 
.^ •^- •--. MEDICAL COLLEGE HOSPITAL 



y 



PHILADELPHIA 
P. BLAKISTGN-^S SON & CO 

10I2 WALNUT STREET 
1906 



^^'S 

^,0^ 



LIBRARY of CONGRESS 
Two CoDies Received 

'JA^ 23 1906 

Copyright Entry 
/ PLASS Ct. XXc. No. 
COPY b' 



Entered, according to Act of Congress, in the year 1906, by 

P. BLAKISTON'S SON & CO. 

In the Office of the Librarian of Congress, at Washington, D. C. 



Press or 

The New Era printing Company, 

Lancaster, P/w 



ABSTRACT FROM PREFACE TO FIRST 
EDITION. 



This Text-Book has been written more particularly to 
meet the wants of students of Legal Medicine. The 
author is aware that the field has already been occupied 
by able and popular treatises on Medical Jurisprudence, 
well known to the professions of Medicine and Law ; but 
an experience of over twenty years as a public teacher 
of this branch of science has convinced him that students 
in both these professions who desire to acquire a knowl- 
edge of Medical Jurisprudence are too often deterred from 
their purpose by being confronted by the ponderous works 
of recognized masters, extending to three, and even six, 
large octavo volumes. 

To avoid the above objection, the author of the present 
work has endeavored to condense into a handy volume all 
the essentials of the science, and to present the various 
topics in a simple and familiar style, giving greater promi- 
nence, of course, to those of the greatest practical impor- 
tance. 

The author has not hesitated to avail himself freely of 
the materials so abundantly presented in the elaborate and 
classic works of Casper, Taylor, Beck, Wharton and Stille, 
Tidy, Guy, Tardieu, and others, always desiring to give 
due credit to the authority quoted, and usually doing so 
at the time; and he would embrace this opportunity to 
express his obligations to these authorities. He is sin- 



VI PREFACE. 

cerely desirous to encourage an increasing interest in the 
students of both Medicine and Law for that most important, 
but too much neglected, subject — Forensic Aledicine ; and 
he would indulge the hope that the present treatise, in its 
unpretentious size and style, may aid in so doing. 



PREFACE TO SEVENTH EDITION, 



The continued popularity of this work, as shown by its 
steady sale, is the best evidence of its adaptation to the pur- 
pose for which it was originally written. Its distinguished 
author was a man of unusually wide experience in the field 
of Medical Jurisprudence and Toxicology, and at the same 
time of high scientific attainments and much experience as 
a teacher. He was therefore able to produce a work rich 
in illustrative materials and to present them in a clear and 
yet concise form. 

In the present revision the principal purposes of the book 
have, as in former revisions, been kept prominently in mind. 
It is essentially a text-book for the student and a manual 
for the attorney and general expert. 

As regards the additions and amendments in the present 
revision, it need only be said that the revisor has endeavored 
to keep the work up to date. Among the new matters may 
be mentioned the application of ;ir-rays to the study of 
development of the skeleton, a method that has direct bear- 
ing on the question of identification. 

Much progress is constantly making in toxicology. New 
methods of treatment are being proposed and applied, and 
the rapidly growing list of synthetic organic remedies has 
led to many new forms of poisoning both acute and chronic. 
Among recently reported cases included in this revision are 
to be noted : Chronic poisoning by potassium chlorate, 
acetanilid and carbon monoxid ; acute poisoning by boric 
acid, resorcinol, wormseed and formaldehyde. 



Vlll PREFACE. 

In these and other recent toxicologic reports, a consider- 
able advance is evident in the precision and fullness of 
clinical history and tests of the conditions of blood and urine 
and in symptomatology. This is the result of the modern 
extensions of laboratory methods in medical teaching and 
shows the value of such work in aiding diagnosis and pathol- 
ogy. As exemplification of these matters, some of the re- 
ports introduced into the present revision have been given 
in considerable detail. The literary precision in these re- 
ports is often not up to the level of the scientific precision, 
carelessness in terms and phrases being often evident. The 
modern system of education is defective on the side of liter- 
ary and linguistic training. 
December, 1905. 



CONTENTS. 

Introduction i- ii 

Phenomena and Signs of Death 12- 42 

Medico-legal Investigations — The Post-mor- 
tem 43- 54 

Presumption of Death and of Survivorship. . 55-60 

Personal Identity 61 - 83 

Causes Producing Violent Death 84-178 

Feigned Diseases 179- 191 

Pregnancy ; 192-199 

Criminal Abortion, or Feticide 200-215 

Infanticide 216-255 

Legitimacy — Inheritance 256-274 

Rape 275-294 

Insanity 295-349 

Malpractice 350-360 

Life Insurance 361 -368 

Toxicology 369-649 

INDEX. 



IX 



TEXT-BOOK 

OF 



MEDICAL JURISPRUDENCE 



AND 



TOXICOLOGY 



CHAPTER I. 

Medical Jurisprudence, Legal or Forensic Medicine, 
may be defined to be the science which appHes the knowledge 
of Medicine to the requirements of Law. In the discovery 
of truth, the great purpose of Law, every department of 
human knowledge should be made to assist. Cases affect- 
ing life, reputation, or property, and requiring for elucida- 
tion and appeal to medicinal knowledge, are termed medico- 
legal cases, and the science of the application of medicine to 
them is named Medical Jurisprudence. 

The students of Medicine and Law are equally interested 
in a knowledge of this science, and it should require no 
argument to show its importance to members of these 
professions. 

Many cases brought before a court can only, be settled 
by an appeal to medical knowledge ; sometimes it is to one 
department of medicine, and sometimes to another; and it 
not infrequently happens that several branches of the science 



2 MEDICAL JURISPRUDENCE. 

may be called into requisition in order to aid in arriving at 
a proper decision. 

It is more particularly when the physician appears upon 
the witness stand, and assumes the functions of the medical 
witness, that medico-legal knowledge is of the most impor- 
tance. After he has accomplished the investigation of some 
case there remains the duty of giving the results of his in- 
vestigations to the court in the form of evidence. This will 
be more manifest as we detail the mode of proceeding in a 
criminal case. 

The Coroner's Inquest. — The first public duty usually 
imposed upon the physician who has been in attendance, or 
has investigated a case of violent death, is to testify at the 
coroner's inquest. In many civilized countries, especially 
English-speaking communities, a special officer, the coroner, 
is appointed to investigate the unknown or unexplained 
causes of sudden death. For example, a body is discovered 
with or without marks of external violence, or dragged out 
of the river ; the body of a new-born child has been found 
in a well or cess-pool, or floating in the water ; a person is 
discovered dead at some hotel, far distant from his home ; 
or a person in apparent health suddenly drops dead in the 
street. In these and in analogous cases the law provides 
for an investigation to ascertain the cause and circumstances 
of the death ; and, if due to violence, then the nature of it — 
i. e., whether from a wound (gunshot or otherwise), from 
a bludgeon, an axe, hammer, or other blunt weapon ; or 
whether occasioned by a fall. In the absence of all external 
marks of violence, then, might the death not have been 
produced by poison? In each one of these cases a further 
question must be solved — was the death homicidal, suicidal, 
or accidental? 



THE CORONER S INQUEST. 3 

The coroner's jury consists of a few men (the number 
varies in different places), mostly selected from the district 
in which the inquest is held. Their duty consists in (i) 
viewing the body and establishing its identity and (2) in 
holding the inquest, which is a sort of petty court, wherein 
inquiry is made as to the cause of death, and (in case of 
homicide) to ascertain, if possible, the guilty person. Wit- 
nesses are examined, and the person who has performed the 
post-mortem examination makes a report and gives his 
opinion as to the cause of death. The jury consult and 
render a verdict. In some cases, particularly in cities, 
where the coroner has one or more specially appointed 
physicians, it is not considered necessary that the jury 
should personally view the body ; it is regarded as sufficient 
if the body has been identified by the examining physician, 
and the autopsy reported. 

The special duty of the coroner's inquest is to discover 
the cause of death; it does not fall within his province to 
discover the individual who caused it. Nevertheless, it 
often happens that, in the course of the investigation, sus- 
picion may so strongly point to some one as to warrant the 
coroner committing the suspect to prison to await further 
investigation. The usual verdict in cases of violent death 
(shown to have been neither suicidal nor accidental) is that 
of murder or manslaughter, against some person or persons, 
known or unknown. 

The office of coroner, as at present constituted in many 
places, exhibits antiquated and inconvenient methods. In 
Massachusetts the office has been abolished, the investiga- 
tion of sudden or suspicious deaths being carried out by 
physicians, called '' Medical Examiners," who do not refer 
evidence to a special jury, but can place any suspected 
criminal in the charge of the courts. 



4 MEDICAL JURISPRUDENCE. 

The post-mortem examination is an inseparable part of 
the coroner's inquiry in a case of this character, and con- 
stitutes its most important factor. It should be performed 
carefully and thoroughly. The autopsy should be per- 
formed deliberately, and by daylight if possible. It will 
always be an advantage if the examination be performed by 
two experts. 

In giving evidence before the coroner's jury, the medical 
witness must not undervalue the importance of the situ- 
ation ; nor forget that the testimony is generally recorded, 
and will be available at a subsequent trial. This fact shows 
the importance of drawing up the report with due care and 
accuracy. 

The Criminal Court. — If the coroner's jury or other pre- 
liminary method if inquiry indicates the probability that a 
crime has been committed, the matter is referred to the 
prosecuting officer, generally called in the United States, 
the District Attorney, who prepares a bill of indictment 
that is a document which sets forth the nature of the crime 
as far as known and the name of any suspected person. 
This bill is submitted to a special body of persons, called 
the grand jury, which deliberates in secret, usually calling 
only such witnesses as the authorities indicate, though it 
may be given power to send for other persons. If the grand 
jury decides that the evidence justifies a trial in open court, 
the document is returned marked " true bill," but if not 
deemed so, the bill is " ignored." A true bill leads to a trial. 
The indictment is read in open court and the accused is 
required to plead guilty or not guilty. To this trial the 
medical witness is summoned to appear by a subpena, which 
must be obeyed. He will undergo a strict and severe ex- 
amination as to his opinions and observations on the case. 



JUDICIAL PROCEDURE. 5 

He will be cross-examined as to his professional knowl- 
edge and acquirements, the extent of his opportunities for 
making such investigations as the one pending, the accuracy 
of his post-mortem or toxicologic examination, and other 
matters which may annoy and confuse him to no small 
degree, unless he be prepared beforehand by medico-legal 
knowledge and training. A witness properly fortified need 
have no fear for himself: for, as he goes upon the stand 
honestly to testify to the truth, he need only, to apply 
the language of the late Dr. Taylor, bear in mind two 
considerations : first, that he should be prepared on the 
subject on which he is to give evidence ; and, secondly, that 
his demeanor should be that of an educated gentleman, and 
suited to the serious occasion on which he appears. 

In regard to medical evidence several points require 
brief notice. After opening the case before the court, the 
prosecuting attorney calls witnesses and examines them 
" according to the rules of evidence " ; this is technically 
called the examination in chief. The cross-examination 
follows ; this is conducted by the counsel for the defense, 
and may be aimed at contradicting and overthrowing, if 
possible, the previous testimony. Attorneys are allowed 
considerable latitude in cross-examination, and it will be 
necessary for the witness to exercise self-control, since in 
this way a brow-beating attorney can be parried. The 
witness must also remember that there are technical methods 
in the law which are not comprehended by others, and it 
is especially advisable that if objection be made by either 
attorney to any question, the witness should pause until the 
matter is decided by the judge. It is inadvisable for a 
witness to appeal to the judge for protection against a line 
of questions. An honest and properly informed physician 



6 MEDICAL JURISPRUDENCE. 

has nothing to fear from any lawyer. Reexamination some- 
times follows the cross-examination of the witness, when it 
becomes necessary to clear up or explain any matter that 
may have been obscured by the cross-examination. 

After the examinations of the witnesses called by the 
prosecuting- officers, the witnesses for the defense are heard. 
The same general line of examination is pursued. When 
expert witnesses for the defense are called, unpleasant ex- 
hibitions frequently take place, one expert directly contra- 
dicting another. Such professional tilting is sometimes 
sneeringly designated as the " war of the experts," and is 
certainly deeply to be regretted, as it tends greatly to prej- 
udice both the court and the public against expert testi- 
mony in general. 

It is well to understand the difference between an ordi- 
nary and an expert witness. The former testiiles only to 
facts which he has seen, or heard, or learned from personal 
observation. The " expert " or skilled witness does not 
necessarily testify to facts, but gives his opinion on facts 
observed by himself or testified to by others. An expert 
witness is supposed to be specially skilled in the matter on 
which he is to testify. It is just here that much difficulty 
arises in cases involving expert evidence. The so-called 
" experts " are often selected with the intention that they 
shall advocate particular views or belittle in every possible 
way the ability or work of the experts on the opposite side. 

The expert witness has his rights as well as his duties and 
responsibilities. One of these rights is his compensation. 
It has often been made a subject of just complaint that an 
expert witness is placed upon the stand and his professional 
opinions, which may be of the utmost value in the pending 
case, extorted from him piecemeal by the questionings of 



MEDICAL EVIDENCE EXPERTS. 7 

counsel, and yet he receives as his compensation merely 
the pay of an ordinary witness. Some legal authorities 
admit that the expert is not bound to submit to this impo- 
sition, and that he is entitled to a special fee for his services. 
In this country the practice of the courts in relation to the 
compensation of medical experts is not settled. In many 
states the law allows no additional compensation to the 
expert, and it is not an infrequent practice to subpena him 
as an ordinary witness, and when in the witness box to 
use him as an expert. What shall the expert do in such a 
case? How shall he conduct himself consistently with his 
own dignity and proper rights? Certainly the court would 
not use a man's private property — the work of his hands, 
his skilled manual labor, or the product of his farm or 
merchandise — without adequate compensation ; why, then, 
should they exact from him that which is the result of the 
labor /of his brain, than which nothing can be more ex- 
clusively and definitely a man's own private property? It is 
to be regretted that so few of our American courts and legis- 
latures have appeared to recognize the true bearings of this 
subject so that with us the old practice still prevails of 
affording no legal protection to the medical expert in the 
matter of fees. 

It rarely happens in important criminal cases, especially 
in poison cases, that either the prosecution or the defense 
would venture to trust their interests to a reluctant witness ; 
and certainly he would be a reluctant witness who had been 
dragged perhaps hundreds of miles from his home and 
business by a subpena which the law forces him to obey, 
and who, after spending, it may be, days in attendance upon 
the court, is compelled to give, for the paltry pittance of 
the wages of a day-laborer, that which has cost him years 



8 MEDICAL JURISPRUDENCE. 

of labor and study to acquire, in the shape of an opinion, 
on which may turn the question of Ufe or death to the 
prisoner. In all such cases the ordinary practice is to ar- 
range beforehand with the expert for his proper fee, and 
the witness should be admonished to look carefully about 
his interests in this matter. Let him remember that the 
district attorney, who usually directs the affair, may have 
no authority to pay the fee ; neither does this authority 
always lie with the court. The responsible parties in the 
case are often the county commissioners, or some equiva- 
lent county authority. With these alone ought the expert 
to make his arrangements, and always previously to under- 
taking the case ; and to these alone can he look, legally, 
for his fee. 

As regards the obligation of a witness to obey a subpena 
when he is to be questioned only as to his opinion, the 
mandate of the court in this country is obligatory ; the 
witness's duty is to obey it, and then endeavor to arrange 
about compensation, if this has not been done, before giving 
his evidence. 

The subject of expert testimony has engaged the atten- 
tion of some of the ablest minds in the professions of law 
and medicine, but with no very definite results. No doubt, 
our present system of volunteer medical experts is open to 
objections, which, under our present laws, cannot be 
remedied. A system is much advocated of each State ap- 
pointing one or more experts, who shall be State officers, 
physicians of thorough education and experience and train- 
ings^' this particular line, who shall devote their time and 
attention exclusively to this duty, and for which they shall 
receive an adequate compensation. Such an office, properly 
filled, and kept aloof from all political considerations, might 



REMUNERATION TO EXPERTS. 9 

be of real benefit ; but it would not, necessarily, abolish the 
unseemly contention of the experts in the court room, for 
in the United States the clause in the Constitution pro- 
viding that in every criminal trial the accused shall have 
the power to call witnesses in his favor and be confronted 
by the witnesses against him will permit of the same con- 
tentions between experts that now occur. Moreover, it is 
not likely that in our present political system a satisfactory 
selection of " State experts " will be made. Social as well 
as political influences will operate to control such appoint- 
ments, and the former as well as the latter are capable of 
promoting unfit persons. The system of State experts is 
in vogue in some countries in continental Europe ; but the 
method of criminal procedure is different in such places, 
and does not exhibit the care of the rights of the accused 
which is the principle of English jurisprudence. It is 
worthy of note that some eminent authorities in continental 
Europe are advocating the adoption of some phases of the 
English system. 

There are a few practical rules relating to the giving of 
evidence which it is well the medical expert should observe. 
He should prepare himself upon all the points bearing on 
the case in which he is called to give evidence. This he 
should do in order to further the ends of justice, and also' 
to avoid personal censure. He should be accurate as to 
weights, measures, distances, size, relationship of objects, 
etc., never guessing, but testifying with certainty and pre- 
cision. 

He should maintain a quiet, dignified, and composed 
demeanor on the stand, not exhibiting any irritability of 
temper, however much he may feel provoked by the rude- 



lO MEDICAL JURISPRUDENCE. 

ness of the opposing counsel. He should beware of any 
display of arrogance or assumption of manner, or of stub- 
bornness or testiness of behavior, which are sure to make 
him appear to disadvantage in the court room. 

The witness should give his answers in a clear and audi- 
ble tone, and these replies, together with his explanations, 
should always be given in the simplest possible language ; 
and they should be free from all ambiguity, otherwise they 
will require explanation, which is apt rather to weaken the 
testimony. It will be better, also, for him to avoid all vol- 
untary remarks, and confine himself closely to answering 
the questions put to him.. 

He should never be afraid frankly to confess his igno- 
rance. Nothing is more dangerous than for a witness to 
attempt to guess, for fear of being thought ignorant. 

He should particularly avoid the use of all technical 
expressions and learned formulae in giving his descriptions. 
Pomposity and pedantry should, of course, be avoided by 
every sensible and well-bred witness, since they are certain 
to expose him to ridicule and contempt. 

Dying Declarations. — By this term is understood such 
declarations as are made by a dying person, who believes 
that he is in actual danger of death, and that his recovery 
is impossible. Such declarations are received in evidence 
without being sworn to. The law presumes that decla- 
rations made at so solemn a crisis as at a dying moment 
must be sincere. They may not, however, necessarily be 
true, although sincere — i. e., believed in, at the time, by the 
deceased. Dr. Taylor quotes an instance of a dying woman 
in St. Thomas' Hospital who accused a man of assaulting 
her. He was found guilty and executed. A year after the 
execution his innocence was established, the real murderers 



EXPERT EVIDENCE. I I 

having been discovered. These declarations, moreover, must 
relate to the actual circumstances of the death, and to noth- 
ing else. 

A magistrate or other official authorized to take deposi- 
tion in important cases, if such can be had, is the proper 
person to take down dying declarations, the physician in 
attendance merely giving opinion as to the hopelessness of 
the case and the soundness of the person's mind. In the 
absence of an official, the medical man is the best substitute, 
and he should content himself by simply writing down the 
exact words of the dying person, without adding his own 
interpretation of them. If possible, the dying person should 
sign the declaration after having it read over. 



CHAPTER II. 

PHENOMENA AND SIGNS OF DEATH. 

Among the numerous and diversified cases claiming 
medico-legal attention, perhaps the most frequent are those 
of violent death. A knowledge of the Signs of Death be- 
comes of the utmost importance, since cases not infrequently 
present themselves in which there is considerable doubt and 
uncertainty as to the reality of the death. 

For a proper comprehension of this subject, attention 
should first be directed to the distinction between molecular 
and somatic death. By the former term is to be understood 
the incessant disintegration of tissue which is^'going on in 
the body during the active processes of life ; the waste of 
material thus produced being compensated by the repara- 
tion. In youth, the supply is in excess of the waste, and 
growth is the result ; in advanced age, the reverse is the 
case. Somatic death is the cessation of all the vital func- 
tions of the body, or the death of the whole body. The 
latter is the popular idea of death, and the time when it 
takes place is generally recognizable. The precise period 
when universal molecular death occurs cannot be accurately 
determined. No doubt, molecular life may continue some 
time after somatic death, as is evidenced by post-mortem 
temperature and muscular irritability, by the post-mortem 
beating of the heart, and by certain acts of nutrition and 
secretion. 

Although the outlets of human life are so numerous and 
varied, and the phenomena of death are diversified, the im- 

12 



PHENOMENA AND SIGNS OF DEATH. 1 3 

mediate or actual cause must in every instance be referred 
to an arrest of the function of one or otlier of the three great 
centers of Hfe — the heart, the kings, and the brain. And 
so intimately are the functions of these three ''centers " 
connected together, that when one ceases to act, the actions 
of the others speedily cease. Each one of these three vari- 
eties has its own special phenomena or signs ; and each 
exhibits its own peculiar or characteristic post-mortem 
appearances. The following is Bichat's classification : ( i ) 
death beginning at the brain, (2) death beginning at the 
heart, and (3) death beginning at the lungs. 

I. Death Beginning at the Brain — Coma. Symptoms. 
— Stupor, more or less profound; insensibiHty to external 
impressions ; loss of consciousness ; breathing slow, ster- 
torous, and irregular ; respiration gradually failing, and 
ceases as the medulla oblongata begins to be affected. The 
chest ceases to expand ; the blood is no longer aerated ; the 
pulmonary circulation is arrested ; the lungs cease to act, 
and finally the heart's pulsations are brought to a stop. 

Post-mortem Appearances. — (i) Effusion of blood or 
serum in the brain or cavities, caused by (a) apoplexy, (b) 
rupture of vessels from injury or fracture of the skull, or 
in disease of the arteries, under excitement. (2) Pressure 
caused by (a) embolism, (b) abscess, tumor, or other or- 
ganic disturbance ; (c) congestion of the vessels of the brain. 
(3) Concussion from a blow or fall. 

II. Death Beginning at the Heart — Syncope. — The 
heart may cease to act from two distinct causes : ( i ) from 
a deficiency in the quantity of blood — its normal stimulant 
(anemia) ; and (2) from a defect in the quality of the blood, 
or from a loss of heart power (asthenia). 



14 MEDICAL JURISPRUDENCE. 

Anemia is produced by sudden loss of blood in disease, 
as in rupture of an aneurysm ; uterine and other hemor- 
rhage ; or by violence, as from wounds of heart and large 
vessels, causing fatal hemorrhage. 

Symptoms. — Paleness of face ; lividity of lips ; vertigo ; 
cold sweat ; slow, weak, and fluttering pulse ; gradual insen- 
sibility. There may also be nausea and vomiting, halluci- 
nations, delirium, jactitations, irregular breathing, sighing, 
and convulsions before death. The nervous symptoms are 
due to want of brain power, in consequence of a deficient 
supply of blood. 

Post-mortem Appearances. — Heart contracted and empty 
(if inspected early). If life has been protracted for several 
hours, a heart clot may be found. General paleness of the 
organs and tissues. 

Asthenia. — Here, the cause of the cessation of the heart's 
action is either a defect in the quality of the blood or some 
disorder of the organs producing a loss of heart power : ( i ) 
by disease, as (a) various cardiac disorders, such as fatty 
degeneration, diseases of the valves, etc. ; (b) all exhausting 
diseases, as phthisis, cholera, cancer, etc.; (2) starvation; 
(3) certain injuries, as blows on epigastrium; (4) certain 
poisons. Cases of heart failure are popularly termed par- 
alysis of the heart. 

Symptoms. — Coldness of hands and feet ; lividity of lips ; 
fingers, toes, nose, and ears ; extreme muscular weakness ; 
feeble pulse ; sense and intellect not affected, but preserved 
to the last. This latter is well seen in the collapse of 
Asiatic cholera. 

Post-mortem Appearances. — The heart not contracted ; its 
cavities contain more or less blood, or else are dilated and 
flabby. Blood in all large vessels, but no congestion of 
lungs or brain. 



PHENOMENA AND SIGNS OF DEATH. I 5 

III. Death Beginning in the Lungs — Apnea — (As- 
phyxia) . — Respiration may be arrested ( i ) by any mechan- 
ical impediment to the ingress of air into the hmgs, as (a) 
pressure of the thorax; (b) tetanic spasm of the muscles 
of respiration; (c) paralysis of the pneumogastric or 
phrenic nerves; (d) exhaustion of muscular power; (e) 
foreign bodies in the air passages; (/) compression of the 
throat; (g) suffocation; (h) drowning. (2) By disease, as 
pneumonia, phthisis, etc., spasm of the glottis, edema of 
the glottis, pharyngeal abscess, embolism of the pulmonary 
artery, and the accumulation of serum, blood, or pus in the 
pleural cavities. (Strictly speaking, most of these diseases 
cause death through mechanical interference with breath- 

Symptoms. — Great dyspnea, lividity of the face, loss of 
consciousness, vertigo, and occasionally convulsions. 

Post-mortem Appearances. — The right side of the heart 
and the whole venous system are usually filled with dark 
blood ; the left side, together with the arteries, is generally 
empty. Cases are, however, reported where the right cavi- 
ties of the heart were found empty. The lungs themselves 
are nearly always gorged with dark blood ; but there are 
some exceptions to this, which will be noticed hereafter. 

By keeping in mind the foregoing varieties of somatic 
death, together with the characteristic post-mortem appear- 
ances attendant on each, the examiner will be considerably 
aided in arriving at a definite conclusion as to the real cause 
of death in any particular case. 

In every inquest over a dead body Hve important ques- 
tions will present themselves for solution : ( i ) The reality of 
the death. (2) The cause of the death. (3) Was the death 
instantaneous, sudden, or was the death agony prolonged? 



1 6 MEDICAL JURISPRUDENCE. 

(4) The time that has elapsed since the death. (5) In the 
case of the body of a new-born infant — Was it born aUve ? 
The first of these questions comprises the phenomena 
and signs of death. How can a case of real death be dis- 
tinguished from apparent death? In the great majority of 
instances, of course, no practical difficulty arises ; but ex- 
ceptional cases do, at times, occur, in which the corpse 
retains so much the appearance of life as to occasion 
doubts. The horror of being buried alive also suggests 
caution in the matter, although cases of premature burial 
rarely, if ever, occur in civilized countries ; yet such may 
have occurred when fatal pestilence has prevailed to such a 
degree as to produce a panic and demoralize the community. 
Dr. Tidy reports that Nussbaum states " that he believes 
many to have b^en buried during the Franco-Prussian war 
who were merely in lethargy from loss of blood, exhaustion, 
hunger, cold and fear." 

The following may be regarded as the Signs of Death; 
but no one sign should be relied upon exclusively : 

I. The Complete and Continuous Cessation of the 
Functions of Circulation and Respiration. — In some cases 
of apparent death — syncope, trance, catalepsy — these two 
functions seem to be suspended for a time; but the sus- 
pension is apparent, not absolute. The absence of the 
pulse at the wrist is not proof of the suspension of the 
circulation, as this may be going on so feebly as only to be 
detected by a very close stethoscopic examination of the 
heart, which should never be omitted in cases of doubt. 
The condition of both the circulation and respiration, in 
such cases of apparent death, simply resembles that of 



SIGNS OF DEATH. 1/ 

certain animals in the state of hibernation. Thus, M. 
Bouchut informs us that in the marmot the heart beats 
during its state of activity amount to 80 or 90 a minute, 
but are reduced to 8 or 9 very feeble pulsations during 
the period of hibernation. Instances are recorded (like 
that of Colonel Townshend, by Dr. Cheyne) of a vol- 
untary suspension of the heart's action; but as these cases 
occurred many years ago, before the discovery of ausculta- 
tion, it is highly probable that the suspension was not 
absolute, but only reduced so as to have escaped ordinary 
notice. It is certainly contrary to scientific reasoning that 
life can continue many minutes without the circulation of 
the blood; therefore one need have no hesitation as to the 
reality of death, if the heart's action has been arrested com- 
pletely for an hour. The converse of this proposition, how- 
ever, is not always true; that is, the pulsation of the heart 
may continue for a brief time after actual death. Duval 
m'^nt'ons having seen the heart of a criminal beat fifteen 
tir.ici: afte decapitation, the left auricle pulsating for an 
hour. Tl .s is corroborated by some observations made in 
Paris upon the body of a decapitated criminal. This same 
phenomenon, as it is well known, is witnessed still more 
remarkably in the heart of the sturgeon, frog, and snapping 
turtle, which will continue to pulsate many hours after re- 
moval from the body. This fact, as also the post-mortem 
contraction of the muscles under galvanic stimulus, proves 
the continuance of molecular life after somatic death. 

This question of the beating of the heart in a still-born 
infant being regarded as a valid sign of life, will be dis- 
cussed later. 

The same remarks may be made with regard to the 
function of respiration. The absolute and continued cessa- 
3 



15 MEDICAL JURISPRUDENCE. 

tion of breathing — say for one hour — may be regarded as a 
positive sign of death. In some cases, as already remarked, 
this function may apparently be suspended without death; 
but it is in reality only reduced to a minimum of action. 
This likewise should be tested by careful and repeated 
auscultation. A common practice is to hold a feather near 
the nose or mouth to serve, by its movements, to indicate 
breathing. So likewise the deposit of moisture on a mirror, 
held in the same position, will indicate the feeblest respira- 
tion. But neither of these is an absolutely positive sign, 
since they both fail when applied in the case of the hiber- 
nating animal which we know is really alive. 

Another method is to place a small vessel containing mer- 
cury on the thorax (the body lying face upward) ; the 
slightest respiratory action will be indicated by the move- 
ments of a reflected image, made to fall on the surface of 
the bright metal. 

It may be remarked that in cases of trance, catalepsy, 
and other instances of suspended animation, the body never 
exhibits either the pallor or coldness of real death. More- 
over, if a ligature be applied around the finger of a corpse, 
no change of color will be observed ; but if the experiment 
be made on a living body, the tip of the finger will become 
of a red or purple color, in consequence of the arrest of the 
capillary circulation at that spot. A ligature around the 
wrist will cause swelling of the dorsal veins of the hand if 
there is any life (B. W. Richardson). The most powerful 
counter-irritants, e. g., oil of mustard, cantharides, etc., will 
produce no redness or blisters on the dead body. 

II. The Condition of the Eyes. — The changes pro- 
duced in the eyes by death are: (i) The entire loss of 



SIGNS OF DEATH. 1 9 

sensibility to light; the pupils neither contract nor expand 
under this stimulus. This, however, is not a positive sign, 
since the same insensibility to light is witnessed during life 
in certain cerebral affections, and is also the result of the 
action of certain poisons. (2) The action of atropin and 
other mydriatics to expand the pupil, and of calabar bean 
(eserin) to contract it during life, is lost within a few hours 
after death. These agents do, however, produce a visible 
effect if applied very soon after the cessation of life, and 
before the body has become cold, and all muscular irritabil- 
ity has ceased. (3) The cornea loses its transparency, and 
the eye-ball its elasticity, very speedily after dissolution. 
But these conditions may likewise exist before death, as the 
results of disease. In apparent death, the cornea retains its 
translucency ; the papilla of the retina is of a rose-red color ; 
and the fundus of the eye is furrowed by the arteries and 
veins of the retina. At the moment of death, the papilla 
of the optic nerve becomes quite pale, and the central artery 
of the retina disappears. It should also be remarked that 
the eye sometimes retains its luster after death. This is 
seen after poisoning by hydrogen cyanid and carbon dioxid. 

III. The Pallor of the Body. — This sign is nearly uni- 
form, though not without some exceptions, as in the case 
of persons of very florid complexions, and in exceptional 
instances when the cheeks and lips retain their rosy color 
for some days after death, so as to occasion some uncer- 
tainty in the minds of relatives. It is also wanting in cases 
of death from yellow fever and jaundice ; moreover, the red, 
inflammatory zones around ulcers and burns, tattoo marks, 
the spots of purpura, and ecchymoses or bruises do not dis- 
appear after death. It must also not be forgotten that a 



20 MEDICAL JURISPRUDENCE. 

death-like pallor is seen in cases of swooning, and some- 
times in the cold stage of ague, and in collapse. 

IV. Loss of Animal Heat. — During life, the body main- 
tains a temperature of about 98° F. independently of the 
surrounding medium. At the moment of death slight rise 
in temperature may occur; but a decline begins soon and 
continues until the body acquires the temperature of the 
surrounding medium, precisely as any other mass parts 
with its heat to the surrounding medium. It never gets 
lower than this medium, unless the temperature of the latter 
becomes suddenly increased ; then, for a while, the body will 
be really cooler than the temperature of the atmosphere. 
Touch is not an accurate measure of temperature, as the 
conducting power of the tissues differs materially. The 
direct application of the thermometer to the body is the 
only safe method. If the temperature in the mouth is lower 
than the surrounding atmosphere, it is, according to Rich- 
ardson, a strong presumptive sign of death. 

The time in which the cooling of the body is completed is 
stated to be, on the average, from fifteen to twenty-four 
hours. Casper makes it from eight to twelve hours. It 
differs considerably, according to the condition of the body 
itself, the medium in which it is kept after death, and the 
manner of death. Fat bodies retain heat longer than lean 
ones ; the bodies of young children and of old persons cool 
more rapidly than those of adults ; while the bodies of those 
who die from suffocation, electric shocks, and from some 
diseases, e. g., yellow fever and tetanus, retain heat longer. 

The body, of course, cools more rapidly if unclothed than 
if covered ; also in a large airy apartment, than in a small, 
close room. It will cool more rapidly in water than in the 



LOSS OF ANIMAL HEAT. 21 

air. In death from chronic wasting diseases, and in cholera, 
the body cools rapidly. According to Taylor, loss of blood 
does not hasten the cooling process. 

The interior of the body retains its heat considerably 
longer than the surface, so that if an autopsy be made 
within twenty-four hours after death, even when its exterior 
feels perfectly cold, the abdominal viscera may exhibit a 
temperature twenty degrees, or more, higher than that of 
the surface. 

It should not be forgotten that coldness of the body is 
a frequent phenomenon of sickness ; it is witnessed in hys- 
teria, ague, and cholera. Its value as a sign of death con- 
sists in the fact that it is progressive and continuous, while 
the coldness of disease is sudden and not permanent. Hence 
the degree of coldness of the body may be an indication of 
the time that has elapsed 'since death, but it is to be noted 
that the rate of cooling after death, although progressive, 
is not uniform ; it is much more rapid during the earlier 
hours than later. Goodhart found that during the first three 
hours after death the loss of heat per hour amounted, in 
the robust, to 3.5°, in the emaciated, to 4.7° ; while when 
the body was nearly cold, the loss per hour was, in the 
emaciated, 1.12°, and in the robust, 1.26°. 

A marked and prolonged rise of temperature after death 
is observed in some cases. This exceptional condition 
occurs occasionally in the bodies of those who have died 
from yellow fever, cholera, tetanus, smallpox, and some 
other acute disorders. The exact cause of this so-called post- 
mortem caloricity is not understood. In some instances the 
increase of heat has amounted to 9° F. Davy records a 
post-mortem temperature of 113° F. in the pericardium. 
Muscular irritability and contractility may continue for 



22 MEDICAL JURISPRUDENCE. 

many hours, under certain conditions, after death, and this 
rise of temperature indicates the continuance of their mole- 
cular activity up to a certain point. 

The injection of a few drops of solution of ammonium 
hydroxid hypodermically leaves no mark in actual death, 
but occasions a dark spot in apparent death. 

V. Cadaveric Rigidity, or Rigor Mortis. — By this is 
understood the stiffening of the body so generally observed 
after death. It usually occurs simultaneously with the 
cooling process. It may be stated to be universal in death 
from any cause, and to be present in the lower animals as 
well as in man. In some instances, however, it is so tran- 
sient as to escape notice. It comes on at periods ranging 
from a few moments to twenty hours after death. These 
differences are chiefly due to the condition of the muscular 
system at the time of death. Its duration is equally un- 
certain; it may last a few moments or many hours, even 
weeks. After the rigidity passes off, the body regains its 
original pliancy and decomposition commences. As a gen- 
eral rule, the putrefaction of the body is retarded until the 
rigor mortis has passed off. 

Cadaveric rigidity usually begins in the muscles of the 
eye, which often become rigid within a few minutes after 
death ; next in the muscles of the neck and lower jaw ; then 
in the chest and upper extremities; afterward in the mus- 
cles of the abdomen and lower limbs. The rigidity generally 
passes off in the same order ; thus, the legs frequently remain 
quite rigid after the upper portion of the body has regained 
its suppleness. 

The seat of the rigidity is the muscular system. That 
it is in no wise dependent upon the nervous system is proved 



CADAVERIC RIGIDITY. 23 

by the fact that all the nerves supplying a muscle may be 
divided and yet the muscle will continue to act, contracting 
under the galvanic stimulus. But response ceases imme- 
diately on division of the muscle. Even the removal of the 
brain and spinal marrow has no effect in preventing the 
muscular contraction. Again, the muscles of a paralyzed 
limb become equally rigid with those in sound health. The 
cause of the contraction is usually ascribed to the coagula- 
tion of the muscular plasma. A rigid muscle is acid to 
litmus ; but it becomes alkaline after the rigidity passes off. 
A rigid muscle is opaque; before death it is partially trans- 
lucent. 

The duration of cadaveric rigidity is one of its most im- 
portant features. As already observed, this differs much in 
different cases, although, as a rule, it does not set in until 
the body has begun to cool ; still, in some of the lower ani- 
mals, and notably in birds, it often manifests itself while 
the body is warm. From the observations of Brown- 
Sequard and others it appears that the period after death 
when the rigidity manifests itself, together with its dura- 
tion, is dependent chiefly, if not altogether, upon the pre- 
vious degree of muscular exhaustion. To understand this, 
it should be remembered that immediately after death the 
muscles are in a state of complete relaxation, giving to the 
body perfect pliancy. This condition may last for so brief 
a time as not to be noticed, though usually it continues for 
three or four hours, after which rigidity commences. Dur- 
ing this period of relaxation, the muscles have not yet lost 
their molecular life, so that they will respond to galvanic 
and other stimuli. Hence, although the contraction of a 
muscle by electricity is no positive sign of somatic life, it 
may be utilized to determine either that the person is alive 



24 MEDICAL JURISPRUDENCE. 

or, more probably, that death has very recently occurred. 
The cessation of all muscular contractility under galvanic 
stimulus is a proof not only of the death of the individual, 
but it also indicates that the death was not very recent — 
hardly within three or four hours. So long as the muscles 
retain their contractility, the occurrence of cadaveric rigidity 
is postponed. 

It can now be understood that whatever produces ex- 
haustion of the muscular system must thereby hasten the 
approach of cadaveric rigidity. Thus, in death from ex- 
hausting diseases, as in phthisis, or after protracted convul- 
sions, or when the muscular system becomes exhausted by 
over-exertion and fatigue, as is seen in over-driven cattle, 
or in animals hunted in the chase, the rigor mortis shows 
itself early, and lasts but a short time ; whereas, if death 
occurs suddenly, in a previously healthy person, the rigidity 
is postponed for many hours, but when once established it 
continues for a much longer period. Thus, according to 
Brown-Sequard, the bodies of decapitated healthy criminals 
were observed not to become rigid until after the lapse of 
ten to twelve hours, and the rigidity lasted over a week, 
even in warm weather. An experiment of the above-named 
physiologist very satisfactorily proves this statement. Three 
dogs of equal size were poisoned with strychnin in different 
doses. One took two grains, and died almost immediately. 
The second took half a grain, and died in twelve minutes. 
The third took one fourth of a grain, and died, after pro- 
tracted convulsions, in twenty-one minutes. In the first 
animal, in which the muscular system had been least ex- 
hausted by the spasms, rigidity did not set in before the 
lapse of eight hours, and the duration was nineteen to twenty 
days. In the second, in which the muscular exhaustion was 



Cadaveric rigidity. 25 

greater, the rigidity appeared after two and a half hours, 
and lasted five days. In the third, in which the muscular 
exhaustion was the most protracted, the rigidity was de- 
veloped as early as thirty minutes, and lasted less than a 
day. 

It has been said that the rigidity does not occur in the 
bodies of persons killed by lightning, but this is an error. 
It is stated to be absent in those killed by some snake-poisons. 
It is not affected by the previous loss of blood by hemor- 
rhage. It is, however, dependent on temperature, as far as 
regards the duration, which is shortened by heat and pro- 
longed by cold. Bodies submerged in cold water retain 
their rigidity for considerable time. 

When a joint or articulation in complete rigidity is forcibly 
bent, the rigidity is destroyed. If, however, the rigidity is 
incomplete, it will be resumed afterward. This may serve 
to distinguish real death from certain cases of catalepsy, 
tetanus, and hysteria, accompanied by rigidity. In all these 
latter cases the stiffness will return on removal of the oppos- 
ing force. 

Cadaveric rigidity is not so strong as voluntary muscular 
contraction. As a rule the flexors are more affected than 
the extensors, so that the limbs are generally found to be 
slightly bent after death. 

The fact that the involuntary muscles are likewise subject 
to it should not be lost sight of, as it might lead to an error 
as to the true state of an organ, on making an autopsy. The 
heart, for instance, may contract firmly after death; this 
might be mistaken, by the inexperienced, for a true contrac- 
tion of the organ, the result of previous disease. 

Closely connected with cadaveric rigidity, if not indeed a 
modification of it, is the condition described as cadaveric 



26 MEDICAL JURISPRUDENCE. 

Spasm. This is exhibited in cases of sudden, violent death, 
when a powerful will action has just preceded death, produc- 
ing strong muscular contraction at that moment. This con- 
traction, moreover, appears to pass at once, after death, into 
the usual cadaveric rigidity. The best illustrations of this 
peculiar condition are afforded in those cases of determined 
suicides who have taken their lives by shooting with a pistol. 
The weapon is often found tightly grasped in the dead hand. 
The same condition is sometimes witnessed in the bodies 
of drowned persons; fragments of wood, grass and weeds, 
or other objects which had been convulsively seized in 
the water before death, being found tightly grasped in the 
hands; and when two persons have perished together by 
drowning, it is not uncommon to find them, after death, 
convulsively clasped in each other's arms. To a similar rea- 
son, doubtless, is to be ascribed the singular and striking 
postures sometimes exhibited by the bodies of soldiers killed 
in battle. Thus, the attitude of one is described as " rest- 
ing on one knee, with the arms extended, in the act of taking 
aim; the brow compressed, the lips clenched — the very ex- 
pression of firing at an enemy stamped upon his face, and 
fixed there by death. A ball had struck this man in the 
neck. Another was lying on his back, with the same ex- 
pression, with his arms raised in a similar attitude, the 
Minie musket still grasped in his hands, undischarged " 
(Taylor). During the American civil- war a brakeman of 
a military train was killed just as he was exerting his full 
power in putting on a hand-brake. The body retained the 
position it had at the moment of death. 

VI. Cadaveric Lividity, or Suggillation. — This term 
is applied to those livid or violet-colored patches or dis- 



CADAVERIC LIVIDITY. 2/ 

colorations which are observed upon the body at variable 
periods after death, usually after several hours. It is the 
result of the settling of the blood in the capillaries by gravi- 
tation. Hence it is noticed in the most dependent parts of 
the body, such as (supposing it to be lying on the back) the 
back, under surface of the neck, calves of the legs and under 
portions of the thighs. These patches, at first isolated, grad- 
ually increase in size and coalesce, so as to cover a large 
surface of the body. Cadaveric lividity is an unquestionable 
" sign " of death. It makes its appearance sometimes much 
earlier than at others, and for this variation no very satis- 
factory reason can be assigned. 

The most important point connected with cadaveric 
lividity is not to confound it with ecchymosis or bruising, 
to which it bears a considerable resemblance. Several 
cases are recorded where a body has been found covered 
with these death-spots, and the mistake has been made of 
supposing them to be bruises and consequently attributing 
the death to violence inflicted during life. The medical 
examiner should be particularly cautious not to confound 
them. Fortunately, a very simple test will settle the ques- 
tion. If the scalpel be drawn through a suggillation, no 
blood will flow ; the most that will be observed will be a 
few bloody points or specks, arising from the division of 
small veins of the skin. If, however, the patch be ecchy- 
mosis (where the effused blood has been infiltrated into the 
cellular tissue), the incision will either be followed by a flow 
of blood or else a coagulum will be seen. Moreover, while 
the ecchymosis is sometimes raised above the level of the 
surrounding skin, the cadaveric stain never is. The change 
of color following an ecchymosis — from purple to green and 
yellow — will also serve as a ground of distinction. These 



28 MEDICAL JURISPRUDENCE. 

cadaveric spots are not affected by age, sex or constitution, 
and they follow upon all kinds of death, not excepting that 
caused by hemorrhage. 

Suggillation takes place in the internal organs as well as 
upon the surface of the body, producing in the former 
appearances strongly resembling true congestion and in- 
flammation, for which they are, without doubt, frequently 
mistaken by the inexperienced, and as it may be a matter 
of considerable consequence in a post-mortem examination 
not to confound these two conditions, the examiner should 
be very cautious as to inferences. These internal suggilla- 
tions are also termed hypostatic congestions; they appear 
chiefly in the lungs, brain, kidneys and intestines. The fact 
that they invariably occur in the most dependent portions 
of these organs should be suggestive of their true origin, 
since a real congestion or inflammation exhibits itself either 
throughout the whole organ or else upon its upper surface 
equally with the lower one; certainly it is not confined ex- 
clusively to the under portion, as is the suggillation. The 
observer should be careful not to be misled by finding sug- 
gillation on the upper part of an organ, as it may have been 
that the body has been recently turned over. When it 
occurs in the intestines, it may readily be distinguished from 
true inflammation by simply lifting up several folds of the 
bowels, when the horizontal line which previously had 
marked the hypostatic settling of the blood becomes imme- 
diately broken and disjointed, whereas, if it had been a 
real congestion or inflammation, the redness would have 
involved the whole circumstance of the intestines and there 
would have been no broken line of separation. 

In the brain, hypostatic congestion might be mistaken, 
by the inexperienced, for one form of apoplexy ; and in the 



CADAVERIC LIVIDITY. 29 

spinal cord, it might be confounded with spinal meningitis. 
In the heart, true suggillation is not believed to occur; but 
this is replaced by the formation of post-mortem clots. 

VII. Putrefaction. — By this term is understood the 
chemical changes undergone by all dead animal bodies re- 
sulting in the elimination of fetid gases. Putrefaction is 
usually regarded as proof of death. The period at which 
it begins differs much, being dependent upon several con- 
ditions, some of which are connected with the body itself 
and others extraneous to the body. 

Among the conditions inherent to the body itself are: 

1. Corpulence. — Fat and flabby bodies undergo putrefac- 
tion more speedily than thin and lean ones, doubtless on 
account of the preponderance of fluids in the former. 

2. Age and Sex.- — The bodies of new-born children and 
(according to Casper) of women dying in child-bed decom- 
pose more rapidly than others, especially the aged. 

3. The Manner of Death. — The bodies of persons dying of 
diseases in which the vitality of the blood has been im- 
paired, as in typhus fever, pyemia, etc., undergo rapid putre- 
faction ; also after death from some poisons, such as hydro- 
gen sulphid ; also from suffocation from smoke, and, in- 
deed, from suffocation generally. Putrefaction is also 
accelerated in bodies that have been much bruised and 
mangled by machinery, or by railway and other accidents; 
but we must except those cases where the body remains pro- 
tected from atmospheric influences, as when buried beneath 
ruins. On the other hand, the process is retarded in death 
by alcohol, phosphorus, sulphuric acid, arsenical compounds, 
and some narcotic poisons. So far as the blood is con- 
cerned, putrefaction is very much delayed in carbon monoxid 



30 . MEDICAL JURISPRUDENCE. 

poisoning. The antiseptic properties of alcohol and arsenic 
are well understood. The action of acids is a direct re- 
tarding influence on the development of the microbes caus- 
ing putrefaction. Admitting all the above conditions, and 
giving them due allowance, there are doubtless other causes, 
as yet unknown to us, which influence the rapidity of putre- 
faction. Casper adduces the instances of four men about 
the same age and general physique, killed at the same time. 
They were buried at the same time, in similar coffins and 
graves ; yet on subsequent examination, the extent of de- 
composition was found to be very different in the different 
bodies. 

The external conditions influencing putrefaction are air, 
moisture, and temperature. These conditions act by reason 
of their influence on the development of microbes to which 
putrefaction is due. Most microbes require oxygen for 
growth and multiplication; all require heat and moisture. 
The processes for preserving perishable articles, such as 
meats and fruits, illustrate these principles. The influence 
of air is not limited to the mere supply of oxygen ; but it 
modifies putrefaction according to the amount of moisture 
it contains. For this reason dry air, such as that of arid 
regions, restrains putrefaction, the body speedily losing its 
fluids by evaporation and shriveling up into a sort of 
mummy. The effects of an entire exclusion of air in re- 
tarding the process of decomposition in a human body are 
witnessed in the burial of royal personages in leaden coffins 
hermetically sealed, and these afterward enclosed in 
marble sarcophagi. When these have been opened, hun- 
dreds of years subsequently, the remains have been found 
fairly preserved. On the other hand, bodies naked, or but 
slightly clothed, and buried in wooden coffins, that soon 



PUTREFACTION. 3 I 

decay, or in shallow graves to which the air has easy access, 
will undergo speedy decomposition. The nature of the soil 
and the depth of the grave also materially influence this 
process. A loose, sandy soil and a shallow grave favor it 
by the ready admission of air, while soil of a stiflf, clayey 
nature and a deep grave would retard it, for the opposite 
reason. 

The different tissues and organs of the body undergo 
decomposition in proportion to the amount of fluids they 
contain. In this respect the immature brain and the eye 
contrast widely with the bones and teeth. The human body 
contains about eighty per cent, of fluids ; hence its great 
tendency to putrefy after death. The bodies of drowned 
persons undergo rapid decomposition, unless the water be 
extremely cold, or contains substances with antiseptic prop- 
erties which prevent the growth of microbes. Bodies thrown 
into dung-heaps and cesspools speedily putrefy. If a body 
be completely deprived of its fluids by drying, putrefaction 
is arrested, as has been noted. 

The influence of temperature as an agent in putrefaction 
is very manifest. The temperature most favorable to this 
process is that between 70° and 100° F. It commences, 
however, as low as 50° ; but it is completely arrested at 
32°, below which the body becomes frozen, and also at 
212°, at which point most microorganisms are killed. An 
animal body may be preserved for an indefinite period if 
completely frozen in snow or ice. It is recorded that the 
body of a Russian nobleman that had been buried in the 
frozen soil of Siberia, on being exhumed after a period of 
ninety-two years, was found in a state of almost perfect 
preservation. 



32 MEDICAL JURISPRUDENCE. 

The effect of temperature in the process of putrefaction 
is familiarly shown in the influence of the seasons. In 
summer a body will decompose very much sooner than in 
winter — a circumstance that should not be forgotten when 
giving an opinion respecting the date of death in an un- 
known case. According to Casper, the relative rapidity 
of decomposition in bodies exposed to the air, kept in cold 
water, and buried in the earth, is in the ratio of one, two, 
and eight ; that is, putrefaction advances as rapidly in one 
week in the open air as in two weeks in the water and in 
eight weeks in the earth (average). 

Dr. Konig, of Hermannstadt, has reported on the ap- 
pearance of a number of bodies of Hungarians taken from 
a deep pool after the lapse of forty years. They were in 
a state of perfect preservation, without a trace of decom- 
position or of the formation of adipocere. The internal 
organs were of the consistence of those of a recently-de- 
ceased person, and the brain was hard, as if preserved in 
spirit. In the interior of these bodies a large amount of 
sodium chlorid was found, crystallized in cubes, deposited 
on the organs, and which had evidently penetrated into the 
bodies from without. These crystals were found even within 
the perfectly closed pericardium and adhering to the heart. 

It may here be remarked that a body floating near the 
top of the water will decompose more rapidly than when at 
the bottom ; and when taken out of the water and exposed 
to the air, the putrefaction will be far more rapid than if 
left in .the water. 

External Signs of Putrefaction. — The following is the 
order generally observed, externally, in the progress of 
putrefaction of bodies exposed to the op'en air. In from one 
to three days in summer (three to six in winter), there ap- 



ORDER OF PUTREFACTION. 33 

pears a greenish or yellowish-green spot upon the abdomen, 
three or four inches in diameter, accompanied with the 
peculiar odor of putrefaction. The eyeball becomes soft 
and yielding within the same period. In a few days more 
this greenish discoloration has spread generally over the 
whole body — first in spots, which subsequently gradually 
coalesce. Dirty red streaks now show themselves through- 
out the surface, marking the course of the blood-vessels. 
In ten or fifteen days (in warm weather) the epidermis be- 
gins to loosen, forming blebs or blisters containing fluid. 
Gases now begin to form in the chest and abdomen, causing 
these cavities to swell out greatly. The eyeballs protrude 
from the same cause ; the face is swollen ; the features are 
so much bloated as to be no longer recognizable. In two or 
three weeks the blebs of the cuticle may have burst open ; 
maggots appear ; the formation of gases increases, so that 
the body, is enormously swollen. If it be now punctured, 
the gas which is emitted will often take fire on the approach 
of a flame. Other gases are likewise formed, the result of 
animal decomposition, as carbon dioxid, hydrogen sulphid, 
hydrogen phosphid, nitrogen, and ammonia. The nails now 
loosen ; and in the further progress of putrefaction the cavi- 
ties burst open and discharge their contents ; the softened 
flesh dissolves off from the bones, which now become ex- 
posed, and ultimately fall apart from the skeleton. The 
sexes cease to be distinguishable, except perhaps by the dis- 
covery of a uterus, which appears to be almost the last 
organ to yield to putrefaction. 

The foregoing description applies to general and average 
cases, since the process of the external putrefaction of the 
body is not uniform, and is influenced by many circum- 
stances, some of which are not yet fully understood. 



34 MEDICAL JURISPRUDENCE. 

Internal Signs of Putrefaction. — The order in which the 
internal organs of the body undergo decomposition being 
more regular as to time, affords a rather better criterion as 
to the period of death. The first organ of the body that 
shows signs of decomposition after death is the lining mem- 
brane of the windpipe (larynx and trachea) ; this assumes 
a dirty red coloration simultaneously with the appearance 
of the greenish spot upon the abdomen. That this is not 
the result of injection of the blood-vessels is proved by the 
microscope. In the earliest stage of death this membrane 
is always very pale, except when the death has been caused 
by laryngitis or suffocation. The examiner should be cau- 
tioned not to mistake this mark of putrefaction for con- 
gestion. Very soon after this stage of redness it becomes 
of an olive-green color, the rings of the trachea separate, 
and it falls to pieces and disappears. 

The next organ to decompose is the brain of young in- 
fants. The reason of this lies, of course, in the fact that 
this organ at such an early age is so very delicate and is 
so little protected by its bony covering from the outer air. 
When decomposing, it changes into a soft, rosy, pulpaceous 
mass, and flows out of the smallest openings. 

Then follows the stomach. This organ is among the 
earliest to putrefy after death. The decomposition first 
manifests itself in discolorations of the fundus, together with 
the formation of dirty red spots or streaks in the posterior 
portion of the organ, owing to hypostatic congestion. These 
spots soon ramify, and cover the whole lining membrane. 
There is great risk of mistaking these spots for signs of 
congestion or inflammation due to irritant poisoning. The 
examiner should be specially cautious on this point, as it 
is often impossible to distinguish them by a merely ocular 



ORDER OF PUTREFACTION. 35 

inspection. A post-mortem redness of the mucous mem- 
brane of the stomach cannot alone prove poisoning. In the 
further progress of putrefaction the stomach softens, the 
spots become greenish and gray, then black, -with dark red 
streaks (veins) running through them. It is finally con- 
verted into a pulpaceous mass, and ceases to be recognized. 

Next to the stomach the intestines follow in the process 
of decomposition. They become discolored, very much as 
in the case of the stomach ; then they become distended with 
gas, burst, and discharge their contents. 

The spleen comes next in the order of putrefaction. If 
not diseased at the time of death, it may retain its integrity 
for two or three weeks. It first assumes a dark red color, 
then a greenish-blue, then becomes soft and pulpy, so that 
its substance can be rubbed down with the handle of the 
scalpel. 

Following the spleen, the omentum and mesentery are 
the organs next to decay. If there is not much fat con- 
nected with them, they will rapidly dry up and disappear. 

The liver resists putrefaction for a considerable time 
after death — in adults for several weeks. In infants it de- 
composes earlier. It first becomes of a green color, then 
black; then softens, shrivels, and finally disappears. In 
case of death by arsenical poisoning the liver might resist 
decomposition for a considerable time. 

The brain of adults does not begin to show signs of 
putrefaction until the end of the fourth or fifth week, and 
sometimes even later. The process is usually most marked 
at the base, which softens and becomes bluish-green, and 
gradually progresses upward and then inward. If the 
brain has been injured, as by a depressed bone, or by a 
gunshot wound, it is affected earlier. 



36 MEDICAL JURISPRUDENCE. 

Next in order is the heart. This is one of the toughest 
of all the organs. The softening here begins in the columnce 
carnecE, and progresses toward the walls of the organ, which 
finally deliquesce into an unrecognizable mass. 

It is remarkable that the lungs, though very soft organs, 
and in such close connection with the air, should resist putre- 
faction so long. These organs are often found quite sound 
for weeks, provided they were healthy and uninjured at 
death. The first evidence of their decomposition is the for- 
mation of little bladders of air in the sulci, between the lobes, 
on the under surface, looking like a string of beads. These 
increase rapidly, the lung structure turning first green, then 
black, and finally softening and disappearing. 

The kidneys follow the lungs. They become reddish- 
brown and soften, then assume a greenish-black color, and 
disappear. Next in order follow the bladder and esophagus ; 
next the pancreas, which, though a soft organ and located 
near the stomach, is among the last to decompose. Then 
follow the diaphragm and the arteries, — the tissue of the 
latter persisting when everything around it has fallen into 
a shapeless mass. 

The uterus is one of the most resistant organs. It has 
been found to retain its identity at the end of seven months 
after death. This fact is of great medico-legal importance 
when the question of pregnancy arises. 

This description of the progress of putrefaction, both ex- 
ternal and internal, is taken chiefly from Casper. It is in- 
tended to represent the average, both as regards appearance 
and time. As already stated, there may be considerable 
deviations from the order laid down, depending upon cir- 
cumstances. Modern embalming has reached such a stage 
of perfection as to delay putrefaction indefinitely. Em- 



ORDER OF PUTREFACTION. 37 

balmed bodies have been exhumed after two years' burial 
and injury proved to the entire satisfaction of an accident 
insurance company, at the instance of which the examination 
was made. The products of putrefaction differ considerably 
with the degree of exposure to air. 

Saponification or Adipocere. — It sometimes happens that 
the process of putrefaction is interfered with under peculiar 
circumstances and gives place to a condition known as the 
saponification of the body. This was first observed by 
Fourcroy, who discovered, during the removal of human 
remains from one of the public cemeteries of Paris, that a 
number of the bodies, instead of undergoing ordinary putre- 
faction, had been converted into a new substance, which he 
styled adipocere. 

This adipocere has an unctuous feel, somewhat like sper- 
maceti and is of a dirty white color. Chevreul found it to 
be an ammonium soap — principally ammonium oleate and 
stearate. The ammonium is derived from the nitrogen of 
the tissues. The presence of water seems to be essential 
to this change. It only occurs in bodies that have been 
buried in wet or very moist soil and never in those in a 
loose or sandy soil. Frequently, when a grave fills with 
water, the contained body is converted into adipocere. The 
same thing may take place in bodies which remain in the 
water for a certain time. 

The composition of adipocere is not always precisely the 
same. It is usually an ammonium soap, but may contain 
calcium — the latter condition existing especially when the 
body has been immersed in water containing notable 
amounts of calcium salts. This was determined experi- 
mentally by Orfila, who placed an ammonium adipocere in 



38 MEDICAL JURISPRUDENCE. 

a solution of calcium sulphate; he found that after a time 
it had been changed into calcium oleo-stearate. Adipocere 
is insoluble in water, but partially soluble in alcohol. It 
emits in burning an odor like that of burning grease. Its 
odor resembles somewhat that of musty cheese. 

From the fact that if a body remain immersed in the 
water for any length of time it is likely to be changed into 
adipocere, it becomes an important medico-legal question 
to establish the period necessary for this conversion. De- 
vergie ascertained that the body of a new-born child was 
more or less changed into adipocere after remaining in the 
water for five or six weeks. We see at once the value of 
this knowledge, since bodies of new-born infants are fre- 
quently thrown into wells, privies and cesspools. If a 
body be found under such circumstances, with the process 
of saponification only just begun, it is probable that it could 
not have been long in the water and vice versa. Accord- 
ing to the same authority an adult body requires an 
immersion in water for one year before the conversion is 
completed, and when it is buried in wet earth, a period of 
three years may elapse before the change is completely 
effected. 

Mummification. — This constitutes another process by 
which the ordinary putrefaction of the body is interfered 
with. By mummification we understand the complete desic- 
cation or drying up of the body. It results either from burial 
in the arid and sandy soil of hot countries, such as Arabia 
and Egypt, or from exposure of the body to a constantly 
cold and dry atmosphere — where, for instance, it is placed 
in a vault through which a constant stream of dry, cold air 
is pouring. Such a condition of things is found at the 



MUMMIFICATION. 39 

Hospice of St. Bernard, in Switzerland. In the charnel 
house attached to this estabHshment the bodies of those who 
have perished in the snows are placed. The atmosphere is 
so constantly cold and dry that the flesh and fat completely 
dry up. 

It is quite impossible, from the mere inspection of a 
mummy, to venture an opinion as to the length of time 
that has elapsed since death. Many Egyptian mummies are 
several thousand years old. 

Some agents retard, and others promote, decomposition. 
In the former class are the antiseptics. Lime, although 
popularly supposed to hasten putrefaction, in reality retards 
it, as is shown by a simple experiment of Dr. John Davy, 
who buried a piece of raw flesh that had been first covered 
over with powdered lime. It continued sound much longer 
than another piece that was buried without the lime. No 
doubt the lime here partly operated by excluding the atmos- 
pheric air. The strong acids and alkalies, although they do 
not hasten putrefaction, produce chemic changes, and in this 
way aid in the removal of a body. 

The period and method of interment materially influence 
the rapidity of putrefaction. If decomposition has set in 
before burial, the action will progress far more rapidly than 
in a body which was interred before putrefaction had begun. 
The depth of the grave and nature of the soil also exercise a 
marked influence. The cause of death may influence the 
rapidity of the decomposition of the body. 

Having disposed of the first question — is the death real 
or apparent ? — we may consider the second : How long a 
time has elapsed since the death? It sometimes becomes 
of extreme consequence to determine this in connection 
with the attempt to prove an alibi on the part of the pris- 



40 MEDICAL JURISPRUDENCE. 

oner. This matter is to be determined, in the absence of 
direct evidence, solely by attending to the different " signs " 
or phenomena of death, already described: The inferences 
may be drawn, first, from the signs occurring before putre- 
faction ; secondly, from those occurring after it. 

1. Inferences From the Signs Exhibited Before Putrefac- 
tion. — If the body is only slightly cold, and rigidity is just 
commencing about the jaws, the eyes glazed, and the eye- 
balls sunken, death has occurred, most probably, from a 
quarter of an hour to four or five hours previously. The 
inference can never be more than approximative for the 
reasons already given. 

Suppose the body to be perfectly cold (externally) and 
rigid throughout; it has probably been dead from twelve or 
fifteen hours, to three or four days. If rigidity is complete 
over the body, and cadaveric lividity (suggillation) is mani- 
fested over the surface, death has probably occurred one to 
four days previously. 

The importance of attending to the above phenomena is 
shown by a case mentioned by Taylor. A man was con- 
victed and transported for killing his wife. The woman was 
discovered, at 8 o'clock in the morning, with her throat 
cut. She was very rigid throughout the upper part of her 
body, and the whole body was cold. The prisoner was able 
to prove an alibi between the hours of 4 and 8 a. m., and 
his counsel endeavored to show that the post-mortem cold- 
ness and the partial rigidity might have developed within 
four hours, which, if true, would have exculpated the 
accused. This point was overruled by a mass of medical 
testimony to the contrary. 

2. Inferences after Putrefaction. — Suppose the body ex- 
hibits the greenish discoloration on the abdomen and the 



INFERENCE AFTER PUTREFACTION. 4 1 

peculiar odor of putrefaction exists; the rigor mortis has 
passed off, leaving the body cold, but pliant: death has 
probably occurred one to three days previously, in summer, 
and three to six or eight days, in winter. 

If the greenish-yellow discoloration extends more or less 
over the whole surface, together with greenish-brown stains, 
and dark red lines over various parts, along with relaxation 
of the sphincter ani muscle, it must have been dead from 
eight to ten days, in summer, and from ten to twenty days, 
in winter. 

If blebs are found over the skin, and some of them 
opened, with maggots in the muscles ; if the body is green 
all over, and the chest and abdomen are enormously dis- 
tended ; the nails loose, or falling out ; the color of the eyes 
not recognizable; the features very much swollen — then the 
death must have occurred two or three weeks previously, 
in summer, or four to five weeks, in winter. 

If the chest and abdomen have burst open and dis- 
charged their contents, and some of the bones are denuded 
of their fleshy coverings ; the eyes enormously swollen ; 
the body has been dead, probably, from two to four months. 

The above " inferences," it must be remembered, are only 
approximative. They cannot be positive under any circum- 
stances ; and, moreover, they are predicated on the suppo- 
sition that the body under examination has not been buried, 
but exposed to the action of the atmosphere. Great care 
must be taken not to give a very positive opinion on this 
question, as the inferences are to a great extent conjectural, 
and dependent on many contingencies. 

Some definition of winter and summer should be given — 
e. g., over 60° for summer, and below this for winter. 

Attempts have been made recently by some French 
5 



42 MEDICAL JURISPRUDENCE. 

observers to determine what time has elapsed since the 
interment of a body, by the succession of various species of 
animal life developing in and about the tissues, and some 
interesting results have been obtained. Such data, how- 
ever, will need to be verified for each district, season, and 
kind of soil before being of any practical value. 



CHAPTER III. 
MEDICO-LEGAL INVESTIGATIONS— THE POST-MORTEM. 

The physician who undertakes the examination in a 
medico-legal case, including a post-mortem, assumes a seri- 
ous responsibility. He must be fully prepared to meet the 
various contingencies that may present themselves, and he 
should execute his work thoroughly and with strict impar- 
tiality. The examiner should be an expert anatomist and 
pathologist, and a close and fareful observer. 

In all cases where dispute is likely to arise, it is advis- 
able to have two examiners, and any suspected person 
should be allowed representation by some one of his own 
selection. It will be proper, however, to secure the con- 
sent of the coroner, public prosecutor, or other officer for 
representatives of suspected or interested parties to be 
present. As a general rule such opportunities are not 
solicited by attorneys representing clients accused of crime. 
The examination should be made by daylight, since artifi- 
cial light conceals shades of color which it is important to 
recognize, such as stains by nitric acid. Analytic and micro- 
scopic investigations are needed in many cases, and great 
care should be taken to place all organs which are to be 
examined for poison in separate clean jars. Many physi- 
cians will thoughtlessly place several abdominal viscera, 
such as liver, kidney, and stomach, in one jar; but this is 
highly objectionable, since it deprives the chemist of all 
opportunity to determine if the poison has been absorbed 
during life, a most important point. If examinations are to 

43 



44 MEDICAL JURISPRUDENCE. 

be made for blood stains, on the clothing of the body or on 
any surrounding objects, these should be marked, wrapped 
up and preferably removed from the room or immediate 
vicinity of the body before the post-mortem is begun, there- 
by avoiding the suspicion that the objects had become 
blood-stained during the post-mortem, which would destroy 
the value of any evidence adduced by future examination. 

The examination should be exhaustive, so that the exam- 
iner may be able to testify with some positiveness as to the 
cause of death. For example, the discovery of a disease of 
the heart sufficient to cause death should not preclude an 
examination of the lungs and brain, in either of which the 
real cause of the death may be found. Poison in the 
stomach may coexist with a ruptured aneurysm, a clot in 
the brain, or a diseased heart. The examination, more- 
over, should be conducted methodically, and all the details 
recorded. 

The post-mortem ought to be made on the first day sub- 
sequent to the death, but it should never be declined on 
account of the interval that may have elapsed, nor even if 
the body be in a state of putrefaction. 

The surroundings should first claim attention, such as the 
locality at which the body was discovered, as this may afford 
a clue, especially in the case of infanticide, when for ex- 
ample, the body of the infant is found in a privy-well or 
dung-heap. Sometimes the body will have been dragged 
by the murderer to a distant spot ; or the victim may have 
followed his assailant a short distance after receiving the 
blow. Footmarks should be noted, together with their direc- 
tion ; evidences of struggling, as denoted by the condition 
of the grass, dust, or mud in the road, and disturbed or 
broken condition of bushes, which also may be bespattered 



THE POST-MORTEM. 45 

with blood ; the finding of a weapon or missile. Marks of 
bloody fingers or blood tracks from bloody shoes should be 
sought for before any blood is drawn by the post-mortem 
examination. If there be no wound or evidence of bleeding 
having occurred from the body under examination, the 
presence of blood on the hands or any part of the clothing 
or body would suggest that his assailant had received a 
wound. If in a room, the position of the body in reference 
to articles of furniture, to any weapon, to glasses, cups, 
bottles, etc., from which poison may have been taken. It 
is also advisable to make a rough drawing of the locality. 

As regards the body itself, the examiner should note its 
exact position when found : this is especially important if 
death was caused by a wound. The clothes should be 
carefully examined to determine whether torn or cut, and 
whether any torn fragment corresponds with the garment 
of the accused, or of the deceased; whether marked by 
blood-stains, or by an acid ; if stabbed, whether the cuts 
correspond with the wounds on the body. The clothes 
should be removed, and the body minutely inspected. It 
should also be identified, if possible. Notes should also be 
made of the sex, height, weight, age, and general develop- 
ment ; of scars and other marks ; abnormalities ; blood, 
seminal, and other stains ; the color of the skin and condi- 
tion of the eyes and teeth ; the temperature and rigidity of 
the body ; the degree of putrefaction ; lividity and ecchy- 
moses ; matters flowing from the nose, mouth, and ears — 
blood from or in either of these orifices is often indicative of 
fracture of the skull ; state of the tongue ; expression of the 
countenance. The hands should be inspected, to ascertain 
if they hold a weapon — whether loosely or tightly grasped ; 
or if portions of hair or clothing are firmly held (denoting 



46 MEDICAL JURISPRUDENCE. 

a struggle), and whether these articles correspond with 
those found on the prisoner; whether stained with blood 
or blackened by powder (the latter indicating firearms). 
The presence or absence of foreign bodies in the nose, 
mouth, anus, and vagina should also be noticed. 

All wounds should be carefully examined as to depth, 
extent, and direction, and whether they suit the weapon 
that may be supposed to have occasioned them ; the condi- 
tion of their edges, as indicating whether recent or not; 
marks of inflammation, suppuration, or gangrene; whether 
any foreign body be present, as a ball, fragments of cloth- 
ing, etc. The scalpel may be used^, if necessary, to enlarge 
the wound, with care not to interfere with its original char- 
acter. If there is contusion without solution of continuity, 
the examiner should not fail to look for internal injuries. 

In fractures and luxations, notice their condition and that 
of the surrounding parts. In cases of hums, observe their 
degree and extent; whether merely inflamed or vesicated, 
and the state of the adjacent parts. 

In females, examine the genital organs, especially in case 
of alleged rape, pregnancy, and recent delivery. 

In new-horn children, ascertain their length and weight, 
their color, sex, diameters of head, the condition of the 
lungs, hair, nails, membrana pupillaris, genital organs, and 
condition of the umbilical cord. The question of a live-birth 
will be treated more fully in a later part of this work. 

The modern methods of photography permit valuable 
pictures to be taken, so as to preserve accurate evidence of 
the surroundings and position of a body. It is scarcely nec- 
essary to refer to the uses that X-ray methods may subserve 
in medico-legal work. 



THE INTERNAL EXAMINATION OF THE BODY. 47 

The Internal Examination of the Body. — It is impor- 
tant that the examination should be thorough and syste- 
matic, and in" order to secure this it will be necessary to 
follow a definite course under all circumstances, or to be 
able to supply a sufficient reason for a deviation in any par- 
ticular case. If the investigator be in the habit of always 
examining the head last, he will be astonished at the amount 
of blood which will escape if the head be examined first, 
and thus, by varying his usual course, may mislead himself, 
attributing the increased flow to abnormal conditions when 
they are not present. The following order is commended 
as offering the best advantages with the fewest variations. 
It is assumed that the external examination has been com- 
pleted. 

The Abdomen. — An incision is made from the interclav- 
icular notch to the pubes, passing to the left of the navel in 
order to. preserve the ligament, and, in the new-born, the 
vessels which pass to the liver. The incision is carried 
entirely through the abdominal wall, care being taken not 
to wound the viscera ; the integument is then dissected from 
the chest wall as far back as the costal cartilages of both 
sides ; by forcibly stretching both sides of this incision, an 
abundance of room will be supplied without any trans- 
verse incisions, except in rare cases ; in stripping the chest 
wall care must be used to avoid the smallest opening of 
the thoracic cavity, as any contained fluids — blood, for 
example — may escape, or entering air may change the 
position of the diaphragm, which it may be important to 
observe. The abdominal cavity is now to be examined 
noting the organs in detail. Note the fluid present; is it 
clear or cloudy ; amount ; search for evidence of peritonitis, 
extravasation of blood or the contents of the stomach. 



48 MEDICAL JURISPRUDENCE. 

intestine, gall-bladder, or urinary bladder, the finding of 
which will indicate that there has been a wound or rupture 
of some of the viscera. If such be found it must be closed, 
and the cavity carefully cleansed and dried before the chest 
is opened, as the foreign material in the belly cavity would 
immediately flow into the chest and complicate the examina- 
tion of the thoracic viscera. The height of the diaphragm 
is to be noted (especially in new-born children, where ques- 
tion of still-birth is likely to arise) before the chest is opened, 
as immediately after no inference can be drawn, as the posi- 
tion of the diaphragm after the chest has been opened may 
change. In cases of suspected poisoning the stomach should 
be ligated at both ends before opening the chest, as the 
gullet might be accidentally wounded, and the stomach 
contents thereby permitted to escape. The abdominal vis- 
cera are not to be examined until after the chest, as the 
removal of any organ will drain the blood from the heart, 
and thereby prevent an accurate examination of that organ. 

The Thorax. — The costal cartilages, together with the 
sterno-clavicular ligaments, should be carefully divided, 
avoiding the large veins of the neck, the pericardium and 
its contents ; the sternum is now reflected. 

Do the lungs immediately collapse, or do they fill the 
chest cavity to distention ? Examine pleurae for adhesions ; 
note character and quantity of fluid in each pleura sepa- 
rately ; remove all fluid from the pleurae in order to prevent 
the pericardium from being flooded when opened. Open 
the pericardium in the axis of the heart, being careful not 
to wound the heart ; this can be best secured by pinching 
up the sac and transfixing, with the back of the knife 
toward the heart, and, as soon as an opening is secured, 
introducing two fingers into the cavity, and thereby protect- 



THE INTERNAL EXAMINATION OF THE BODV. 49 

ing the heart. Note the character and quantity of the 
pericardial fluid ; note the condition of the heart as to 
distention of cavities ; see that the great vessels given off 
from the heart are in the normal relation to that organ ; 
open the heart in situ ; note in detail the contents of the 
cavities ; is the blood fluid or in clots ? are the clots white, 
black, or red? This is important, as it may establish 
whether the death was sudden or prolonged. If the right 
side of the heart contain distinct ante-mortem clots, it is 
highly improbable that the death could have been sudden, as 
by drowning. A man was found in the water three months 
after his disappearance, and it was presumed that he was 
murdered and thrown into the stream. At the post-mortem 
evidence was found of ante-mortem injury, and clots were 
found in the cavities of the heart; but no note was made 
of their character, and the plea of accidental drowning, set 
up by the defense, could not be refuted. Had the medical 
examiner been able to testify that the clots were undoubt- 
edly ante-mortem, it would have established that the 
death was considerably slower than could have been the 
case in drowning. Distinctly ante-mortem clots are posi- 
tive indications of the death agony not having been instan- 
taneous, and may, for this reason, be of the greatest im- 
portance in establishing the exact time at which the injury 
was received or the poison given. The heart may next be 
removed by cutting through the vessels at its base, and 
examined as to its weight, condition of its walls and tissue, 
and state of its valves. Sometimes a microscopic investiga- 
tion may be required. The aorta should likewise be ex- 
amined for atheroma and aneurysm. 

The lungs may be removed by passing the hand beneath 
them (noticing any adhesions), and cutting through the 
6 



Jo MEDICAL JURISPRUDENCE. 

bronchi and vessels at their roots. They should be in- 
spected as to their color, density, etc., as indicating disease ; 
the condition of the bronchial tubes and pulmonary artery 
(embolism) ; and the presence of foreign matters in the air 
passages (in case of drowning or of sudden death). A man 
in apparent health, while away from home, became sud- 
denly cyanosed and fell unconscious from his seat at the 
table after eating heartily. Relatives claimed that he was 
poisoned. A careful examination revealed the presence of 
an irregular fragment of a potato in each bronchus, com- 
pletely occluding the entrance of air ; and it was afterwards 
shown that he habitually bolted his food. A cud of tobacco 
or stump of a cigar might as easily give rise to the same 
difficulty. If blood has escaped into the thorax it should be 
removed by a sponge, so as to ascertain the color of the 
parts. The hydrostatic examination of the lungs in new- 
born children, in cases of infanticide, will be considered fur- 
ther on. 

The ribs should be examined in succession for evidence 
of fracture or other injury. The esophagus may be cut 
from its attachments in the neck, stripped from the chest, 
and left to be removed with the stomach ; a ligature, in case 
of suspected poisoning, should be placed at the cardiac end 
of the stomach to prevent regurgitation of the gastric con- 
tents ; the esophagus may be opened down to the ligature, 
and its interior examined for corrosion or other evidence of 
poison or injury. The organs of the abdominal cavity are 
to be next examined — the spleen, kidneys, and bladder. If 
any urine be present in the bladder, it should be carefully 
preserved in a chemically clean bottle, that it may be ex- 
amined for albumin, sugar, or for poisons ; in the latter case 
some of the alkaloidal poisons (atropin, strychnin, etc.) can 



THE INTERNAL EXAMINATION OF THE BODY. 5 I 

be physiologically tested for by injecting some of the sus- 
pected urine, hypodermatically, into susceptible animals, or 
chemically, as will be discussed later. The internal and 
external genital organs are to be examined next, and, in the 
female, the uterus especially, for evidence of pregnancy, 
abortion, or delivery. The liver should be next examined. 

The Stomach should be examined by first ligating it at 
the cardiac extremity, and then by applying two ligatures 
at the pyloric end, and cutting between the latter. Note 
the general external appearance, and then open it along its 
lesser curvature. Examine the contents, as to quantity, 
character and odor, and reaction. Carefully inspect the 
lining membrane with a lens for solid particles of phos- 
phorus, crystals or patches of arsenic, or other mineral 
poisons, fragments of leaves or seeds, or other foreign 
matters. Note any evidences of inflammation or ulceration. 
If an analytic examination of the stomach and its contents 
is to be made, it is better if it can be so arranged not to 
open the stomach until it is delivered to the chemist. Under 
ordinary circumstances, except in well-appointed morgues, 
no facilities are at hand for examining for crystals, frag- 
ments of leaves, etc., and hence this had better be deferred 
until the chemist has access to the organ. 

The Intestines^ after inspection for twist, strangulation, or 
hernia, should next be examined, by removing them from 
their attachments, and slitting them throughout with an 
enterotome ; looking for inflammation and ulceration of the 
glands, and for any foreign matters ; also noting the condi- 
tion of the appendix vermiformis. In cases of poisoning, 
the stomach and its contents should be preserved for chemi- 
cal examination in a separate jar. The intestines also (at 
least a portion of the small and large bowel, together with 



52 MEDICAL JURISPRUDENCE. 

the rectum), and portions of the Hver, one kidney and the 
spleen should be kept for a similar purpose. The jars con- 
taining the viscera should be securely stoppered and sealed 
with the private seal of the examiner, with a label affixed, 
stating the name of the deceased person, the date of death 
and of the autopsy. They should then be delivered per- 
sonally, by him, to a responsible party, from whom he should 
always take a written receipt. The preservation of each 
organ in a separate and well-cleaned — preferably new — jar 
is to be especially urged. Toxicologic examinations are 
often seriously hampered by the fact that stomach, liver, and 
kidneys have been placed in one large jar. Such a condi- 
tion prevents determining the ante-mortem distribution of 
the poison. 

The Head. — After a careful external examination for 
wounds or injuries, for which purpose the hair may have to 
be removed, the scalp should be separated by an incision 
from ear to ear across the vertex, down to the bone; it 
should then be everted in both directions so as to expose 
the skull. Search for fractures, and do not mistake irregu- 
lar sutures for these. Blood along the line of a suture can 
be wiped off, along the line of a fracture it cannot; gentle 
tapping on the bare skull may give a " cracked pot " sound 
in fracture. Notice any unusual thinness of bone; follow 
out any fracture to its whole extent; observe any extrava- 
sation of blood under the scalp. 

The skull should now be carefully sawed around, about 
half an inch above the opening of the ear, the calvaria 
removed (under no circumstances should the hammer or 
chisel be used), and the condition of the dura mater noticed. 
Look for hemorrhage, either extradural or subdural ; of the 
dura has come off with the calvaria, it should be stripped 



THE INTERNAL EXAMINATION OF THE BODY. 53 

and the inner table of the skull cap closely inspected for any 
fracture which may or may not show on the outside. This 
membrane should be carefully cut around with a probe- 
pointed scissors and the arachnoid and pia mater closely 
inspected. 

The upper part of the brain can now be examined before 
removal — as to congestion of its vessels, laceration, or ex- 
travasation of blood upon its surface. This latter is often 
seen on the side opposite to the external injury. The brain 
is to be carefully removed, by inserting the fingers beneath 
it and dividing the medulla oblongata. The base of the 
skull should be carefully inspected for fractures. 

The brain should be examined from above, slicing it hori- 
zontally; regarding specially its consistence, color, presence 
of extravasated blood or serum, of tumors or abscesses, 
disease of blood-vessels or of the membranes. In opening 
the skull of very young children a pair of strong scissors 
may be used instead of a saw. 

The Spinal Column should be opened through its whole 
extent, by sawing through on each side of the spinous proc- 
esses. The cord, together with the dura mater, should then 
be removed and examined. Note any fracture, dislocation 
or contusion. 

The Neck should be inspected for marks of violence by 
the fingers (garroting) ; by a cord (strangling or hanging), 
and for ecchymoses. Note should be taken as to the con- 
dition of the great vessels and nerves. The cavity of the 
mouth and nose should be examined ; also the condition of 
the larynx, trachea, pharynx, and esophagus. 

In case of disinterment of a body the inspectors should 
always view it before it is removed from the coffin ; at which 
time, also, it should be properly identified by the friends or 
relatives of the deceased. 



54 MEDICAL JURISPRUDENCE. 

In a medico-legal examination of a body, such as above 
described, there should always be present either a second 
inspector or a clerk to take down the notes as the autopsy 
progresses. These notes should comprise the appearances 
presented by the different organs, stating facts, not opinions. 
The notes should be read over by both examiners and, if 
necessary, corrected before sewing up the body. In many 
cases it will be expected that a report should be drawn up 
containing opinions of the case. The length and character 
of this report will depend on circumstances. 



CHAPTER IV. 
PRESUMPTION OF DEATH, AND OF SURVIVORSHIP. 

Presumption of Death. — This question may be raised 
when a given person is not heard of for a long period. 
The law, in that event, presumes death, and the adminis- 
trator or executor may proceed to settle the estate. This 
question is not often raised in life insurance cases, when 
the party insured has not been heard of for many years, 
and the lawful heirs demand the payment of the policy. It 
must also be considered in cases in which either married 
person leaves the other and remains continuously away. 

The length of time usually regarded by the law as war- 
ranting a presumption of death, in any of the above cases, 
is seven years from the time the person was last heard 
from ; so that in the case of married persons it is not 
regarded as bigamy if either party should marry again 
after the expiration of the seven years of continuous absence 
without communication or information of any kind on the 
part of the other. In cases of heirship and property, and 
in some cases of life insurance, it is often not considered 
necessary to wait the whole seven years, but settlements 
have been made by the courts or companies in two years. 

The presumption of death must depend on general evi- 
dence, being a presumption of fact to be determined by a 
jury. There are cases, however, of a special character, 
where the courts have decided the presumption of death to 
be sooner or later than the period of seven years, as, e. g., if 
the individual concerned was in feeble health when last 

55 



56 MEDICAL JURISPRUDENCE, 

heard from. This question would involve medical evidence 
as to the probabilities of life in such a case. 

Presumption of Survivorship. — Questions relating to 
presumption of survivorship are much more frequently dis- 
cussed in the courts than those pertaining to presumption 
of death. There is, however, no general law upon the sub- 
ject, either in this country or Great Britain, every case in 
which the question is involved being decided according to 
its individual merits. When two or more persons perish by 
the same calamity, in the absence of all testimony the 
courts frequently refuse to assume that one survived the 
others, but have decided that all perished together. Yet 
momentous questions may be dependent upon a legal de- 
cision of the question of survivorship ; as when the parties 
dying are a father and a son; if the son survive but for a 
moment, " his wife shall have dower, for the lands descended 
the instant the father died." So, in the case of a testator 
and legatee: if the latter die first, the legacy lapses; but 
if he survives the testator for ever so short a time, his execu- 
tors can claim. So, again, the husband of a woman possessed 
of freehold property (not specially settled) has a life inter- 
est in her estate, provided she has issue by him, born during 
the life of the mother, and which survives her even for a 
moment of time (tenancy by courtesy). The old Roman 
law upon this subject, upon which are based most of our 
modern decisions, enacted that when persons of different 
ages perished in battle, those under puberty were deemed 
to have died first; but if the son was above the age of 
puberty, and both died together, the son was presumed to 
have survived the parent. In the case of husband and wife, 
the husband was presumed to be the survivor (Beck). 



PRESUMPTION OF SURVIVORSHIP. 5/ 

According to Fodere and Beck, the French law, as con- 
tained in the Code Napoleon, is as follows: 

'' I. If several persons, naturally heirs of each other, per- 
ish by the same event, without the possibility of knowing 
which died first, the presumption as to survivorship shall be 
determined by the circumstances of the case ; and in default 
thereof, by strength of age and sex. 

" II. If those who perished together were under fifteen 
years, the oldest shall be presumed the survivor. 

" III. If they were all above sixty years of age, then the 
youngest shall be presumed the survivor. 

" IV. If some were under fifteen, and others above sixty, 
the former shall be presumed the survivors. 

" V. If those who perished together were over the age of 
fifteen, but under sixty, the males shall be presumed the 
survivors, where the ages are equal or the difference does 
not exceed one year. 

" VI. If they were of the same sex, that presumption 
shall be admitted which opens the succession in the order 
of nature. Of course, the younger shall be considered to 
have survived the elder." 

According to Section IV. in the above Code, no distinc- 
tion is made between an infant and a man of sixty years ; 
yet certainly it may fairly be supposed (as remarked by 
Dr. Tidy) that the latter had a better chance of life than the 
former. The Prussian law on this question is about iden- 
tical with the Code Napoleon. These principles are not a 
part of the law in the United States or England, except in 
Louisiana, which has adopted many of the principles of the 
Code Napoleon. 

Although our laws are not decisive on questions of pre- 
sumption of survivorship, but treat them as questions of 



58 MEDICAL JURISPRUDENCE. 

fact depending wholly on evidence, and in the absence of 
all evidence, regarding them as matters incapable of being 
determined, still, there are matters of importance connected 
with each case as it presents itself which deserve consider- 
ation in influencing the decision. These points may be 
considered under the following heads : 

1. Prohabilities Afforded by the Age. — Between a father 
and a child under puberty, the English civil law decides 
the father to be the survivor. Between the ages of fifteen 
and sixty there is no probability. Between a middle-aged 
man and one under fifteen or over sixty^, the probabilities 
are in favor of the former. Between one under fifteen and 
one over sixty, the former is deemed the survivor ; but the 
same exception might be taken here as in the case of Section 
IV. of the Code Napoleon. Between two under fifteen, the 
older is considered the survivor. If the question is between 
a mother and infant, both dying in childbed, without assist- 
ance, the presumption of survivorship is in favor of the 
mother, because the child might be still-born, and also 
because, if large, its life might be endangered by delay, and 
it would be more exposed to danger without assistance, such 
as strangulation by the cord or suffocation in the discharges 
of the mother. 

2. Presumption Afforded by the Sex. — The presumption 
is in favor of the male, when it is a question of physical 
strength and courage, as when a man and woman perish 
together by drowning, or some other casualty. But in 
particular cases, the question of the respective health of the 
two persons might have to be considered. When, how- 
ever, it is a question of passive endurance, especially where 
insensibility supervenes^, then the presumption is in favor of 
the female. 



PRESUMPTION OF SURVIVORSHIP. 59 

3. The Cause of Death, as affording a presumption of 
survivorship. In death from asphyxia (apnea), as in 
smothering, or breathing noxious gases, as women require 
less oxygen than men, the probabilities are in favor of the 
former, other things being equal. Thus, it is stated that 
in Paris, in one year, there occurred three hundred and 
sixty cases of poisoning by charcoal vapors ; of this num- 
ber there were nineteen instances where a man and a 
woman were exposed together, and of these only three sur- 
vived, and all were females. Dr. Beck relates the case of a 
man, wife, and child, who were all asphyxiated while sleep- 
ing in a room which was exposed to the vapors of a coal 
stove. In the morning the man was found dead, the child 
dying, but the woman recovered. 

In drowning or shipwreck, the question becomes very 
complicated, having to take into account the age, sex, 
strength, and opportunity. Thus, men being stronger, 
more likely to be able to swim, and in case of shipwreck, 
being more apt to be on deck, and, therefore, in a better 
position to escape, have the best probabilities for survival ; 
but, on the other hand, the buoyancy of a woman's clothes 
might support her in the water, and thus save her life, under 
possible circumstances. In case of two or more persons, 
all males, equally exposed, a presumption of survivorship 
can only be entertained by searching for bodily injuries, or 
other weakening causes, which would necessarily interfere 
with the individual's exertions to save his life. Here, also, 
their respective swimming capacities would have to be con- 
sidered. 

If the question be on the survivorship, in the case of several 
persons exposed to excessive cold, the amount of clothing, 
the physical condition, and the immoderate use of alcohol 



6o MEDICAL JURISPRUDENCE. 

must all be considered before arriving at a conclusion. The 
probabilities would here be in favor of the strong adult 
over the very young, or very old person, and of males over 
females. The debilitating effects of poverty, entailing a 
bad nutrition, and also of intoxication, as being especially 
obnoxious to the effects of cold, should not be overlooked. 
The perishing of drunken persons on a cold winter's night 
is a familiar occurrence. In relation to the effects of heat 
it may be remarked that, while the young and old suffer 
more from cold than adults, they seem able to withstand a 
greater amount of heat than the latter. 

In death by starvation, the general principle that the 
young require more food than the aged will determine the 
presumption of survivorship to be in favor of the latter; 
also for the female, rather than the male. Certain circum- 
stances, however, should here be considered;, such as prox- 
imity to water, which would aid in sustaining life for some 
time, even without food. 



CHAPTER V. 
PERSONAL IDENTITY. 

The medico-legal consideration of the subject of Personal 
Identity is much more important than it may appear at first 
sight. The question is often raised in trials and it may 
constitute the chief link in the chain of evidence. Cases of 
mistaken identity are constantly occurring and proofs abund- 
ant might be adduced to show that innocent persons have 
frequently been made to suffer judicial penalties, simply 
through an error of this nature. Should an alleged child, 
or other claimant, present his claim to an inheritance, he 
must first establish his identity before taking further steps 
in the suit. If an individual is assaulted or robbed, he 
will be required to identify his assailant before he can 
successfully prosecute him. Again, a person, after many 
years' absence in foreign climes, returns home to claim his 
rightful property or title; but he is so changed as to be 
unrecognized by his nearest relatives ; he must be able to 
prove his identity before the courts before his claim can be 
sustained. In relation to persons found dead — whether in 
cases of recent death, where the body has undergone but 
little change, or years after the decease, where nothing re- 
mains but the skeleton — the question of personal identity 
acquires the most intense interest, especially in a trial for 
murder, where it becomes essential to establish the identity 
of the alleged victim. 

The aid of the physician is not so frequently invoked for 
proving the identity of the living, since this can generally 

6i 



62 MEDICAL JURISPRUDENCE. 

be established as satisfactorily by friends and neighbors. 
Still, there may be occasions of unusual complexity in which 
a professional opinion may become requisite, as, for example, 
to verify certain deformities, fractures, scars and other marks 
about the person, when these constitute the evidences on 
which the identification may depend. 

The subject will be considered under the two divisions of 
(i) The Identity of the Living and (2) The Identity of the 
Dead. 

I. The Identity of the Living. — This may usually be 
established by the direct evidence of witnesses who have 
known the individual sufficiently long to have a distinct 
recollection of his personal appearance; such is the testi- 
mony of relatives, friends, and acquaintances. Although 
among the myriads of the human family it is very rare to 
find two persons exactly alike in all points, yet remarkable 
instances do occasionally occur where the personal resem- 
blance is so striking as to baffle even the skill of the detec- 
tive, and this resemblance has been made still stronger by 
the existence of similar marks, cicatrices or certain pecu- 
liarities of structure in both individuals. Some striking 
illustrations might be given of the extreme difficulty — 
amounting, at times, to an impossibility — of deciding the 
question, which also goes to show how easily witnesses may 
be mistaken in their evidence on this subject. Only two 
will be here referred to. 

In the year 1560, the celebrated case of Martin Guerre 
and Armand du Tilh was tried before the Parliament of 
Toulouse. Martin had been absent from his home for 
eight years, when the person named du Tilh appeared and 
represented himself as the long-absent man. So strong 



IDENTITY OF THE LIVING. 63 

was the resemblance, that his statement was universally 
accepted by all of Giierre's family, including his wife, four 
sisters, and two brothers-in-law, among whom he lived un- 
suspected for three years. About this time, however, some- 
thing occurred to excite suspicions as to the true character 
of the supposed husband and brother, when he was arrested, 
and brought before the tribunal, on a charge of fraud. 
Upon his examination he gave satisfactory answers to the 
most minute questions in relation to Guerre's former life. 
Some one hundred and fifty witnesses were examined dur- 
ing the investigation, of whom between thirty and forty 
testified, from a life-long acquaintance, that the prisoner 
was Martin Guerre; while about the same number swore 
positively that he was Armand du Tilh, whom they well 
knew ; and over sixty, who knew them both, declared that 
they were unable to say which the prisoner was. Finally, 
however, the real Martin appeared upon the scene, when 
he was immediately recognized. The four sisters who had 
previously testified that du Tilh was their real brother now 
admitted their error, and acknowledged the distinction. 
There being now no doubt of the guilt of the prisoner, he 
was condemned, and afterward executed. 

The other instance is afforded in the recent famous Tich- 
borne case, in which a person named Orton, with various 
aliases, undertook to personate an English baronet, heir to 
a large entailed estate. So successful was his scheme that 
" he was sworn to be Sir Roger Tichborne by eighty-five 
witnesses, among whom were Sir Roger's mother, the 
family solicitor, one baronet, six magistrates, one general, 
three colonels, one major, two captains, thirty-two non- 
commissioned officers and privates of the army, four clergy- 
men, seven tenants of the Tichborne estates, and seventeen 



64 MEDICAL JURISPRUDENCE. 

servants of the family." The claimant also gave proof of 
" a fish-hook wound on the eye, of a mark of bleeding on 
the ankle, and a peculiar scar on the head," all of which 
the genuine Sir Roger possessed. The case, however, broke 
down on cross-examination, many circumstances being 
proved against the claimant, which need not be here enumer- 
ated. Suffice it to say that a verdict was taken against him, 
and that an indictment was found against him for perjury. 

Now, as a fair inference from the above two instances 
and other remarkable cases, we may assume that appear- 
ances are not conclusive evidences of personal identity, 
because these appearances convey different impressions to 
different observers ; and as a result of this discrepancy, we 
must admit the fact that " a large proportion of ordinary 
persons are very untrustworthy witnesses to identity when 
dependent on appearances alone. They are, from nature 
or habit, incapable of appreciating form, and form alone is 
the unerring proof of personal identity. The difficulties in 
the *way of identification, more especially of the dead, are 
to them insuperable." To this inherent difficulty on the part 
of the witnesses may be added their want of previous train- 
ing as minute observers, and also the well-known fact of 
the adroitness of criminals at personal disguisement. 

A second means of establishing the identity of the living, 
especially in a criminal, is by certain peculiarities in the 
appearance, which are noticed at the time of the commission 
of the crime, and which are, therefore, apt to leave a strong 
impression on the senses, such as (a) size, when the indi- 
vidual is very tall or very short, very corpulent, or very 
slim ; whether lame, or otherwise deformed; (b) dress, when 
a portion — sometimes a mere shred — of the prisoner's dress 
is discovered near the seat of the crime, or which may have 



IDENTITY OF THE LIVING. 65 

been retained in the grasp of his victim, and which exactly 
corresponds with the rest of the garment found on his 
person, or in his own house. 

A third means of identification is afforded by the voice. 
PecuHarity of the voice (such as depth or shrillness, lisping 
or stammering) always makes a strong impression upon 
those who hear it, and constitutes a valuable aid in personal 
identification. 

Fourthly, the presence of certain- peculiar marks, either 
natural or acquired, about the person, often affords material 
aid in establishing identity. These marks comprise moles, 
nevi, scars, cicatrices, deformities, fractures, tattoo-marks, 
etc. Such marks are usually well known and remembered 
by relatives and friends of the individual, who can usually 
identify them. Some of these remain upon the body during 
life; others gradually decline and fade away. In relation 
to tattoo-marks, Casper's experience leads to the inference 
that some of them (the red ones) are gradually obliterated 
by time, while the black and purple ones are more perma- 
nent. A cicatrix is permanent during life, if there has been 
any original loss of substance. Even the cicatrix made by 
the lancet in venesection, at the bend of the arm, usually 
remains during life. It may not always be distinguished 
from the surrounding skin, unless the part be smartly 
rubbed, when the white scar is immediately manifested on 
the red surrounding surface. Caution should be observed 
against too strong reliance upon scars as a means of iden- 
tity, since these may, at times, be discovered upon another, 
precisely similar, both as to form and situation. 

Under this head may be mentioned the appearance of the 
hands (whether hard and horny, or soft and pliant, or 
7 



66 MEDICAL JURISPRUDENCE. 

whether stained in a peculiar manner), as often indicating 
the nature of the occupation of the individual. 

Iri no small number of cases now recorded, the teeth 
have been essential links in the chain of identification. Es- 
pecially is this the case when the individual has been under 
the care of a dentist, irregularity of toothline, fillings, evi- 
dence of extracted teeth and insertion of artificial teeth all 
being identifiable by the dentist. 

Photographs and other portraits of the suspected person 
are sometimes useful aids in the identification of the living, 
as well as of the dead; but caution is requisite here, since 
the art of the photographer in the touching up of the pic- 
ture frequently makes it an unfaithful representation of the 
features. 

As bearing upon this subject, it may be proper to say a 
few words upon vision and hearing. The limits of normal 
vision or healthy sight, unassisted by instruments, in a per- 
fectly clear atmosphere, are stated to be as follows : 

At a height of 5 feet, the range of distance is 2.96 miles. 

20 " *' '< 5.91 " 

50 " " " 9-35 " 

100 '* " " 13.2 " 

500 '' «« '« 29.5 

1000 <* " " 41.8 " 

5000 •* ** ** 94 " 

It follows from this that a man of ordinary height may 
be seen on level ground at a distance of two or three miles 
on a clear day ; but this is very different from recognition of 
the person so as to identify him. The effects of age upon 
the acuteness of vision are considered by Dr. De Gueret to 
be as follows : 

At fifty years it is diminished one fifth; at sixty years, 



IDENTITY OF THE LIVING. 6/ 

one fourth ; at seventy years, one third ; at eighty years, 
one half. In other words, if a man of thirty or forty could 
distinguish an object at one hundred feet distance, at sixty 
years of age he could not recognize it further off than 
seventy-five feet, or at eighty years at fifty feet. 

The recognition of persons at a nearer or greater distance 
is afforded by their stature, gait, complexion, color of the 
hair and eyes, and peculiarities of appearance. According 
to the above authority, the best-known persons can be 
recognized often with difficulty, in broad daylight, at one 
hundred meters, or about one hundred and nine yards. Less 
known persons may be recognized, in broad daylight, at 
sixty to one hundred yards ; and people who are almost 
strangers, and who have no personal peculiarities, at twenty- 
seven to thirty-three yards. By the clearest moonlight, the 
best-known persons cannot be recognized further off than 
sixteen or seventeen yards. By starlight, recognition cannot 
be effected beyond ten to thirteen feet. The light of a flash 
of lightning enabled a lady, on her passage home from India, 
to see distinctly the features of a man who was robbing her 
trunk in the cabin of a vessel, on a very dark night; and 
authentic instances are given where, by the flash of a pistol 
or gun, sufficient light was momentarily afforded to enable 
not only an assailant to be recognized, but likewise the color 
and appearance of his horse. 

The distance at which sounds (such as the report of a 
gun or pistol) continue to be audible cannot be determined 
with accuracy, since it depends upon the direction of the 
wind, the condition of the atmosphere as to moisture, and 
other disturbing sounds. The velocity of sound may be 
stated to be, on an average, 1,135 ^^^^ P^^ second, which is 
about 13 miles a minute, or one mile in about 4^ seconds. 



6S MEDICAL JURISPRUDENCE. 

II. The Identification of the Dead. — This may have ref- 
erence (i) to the body recently dead, but entire; (2) when 
the body has been mutilated and only parts of it are sub- 
mitted, and (3) when the soft parts have disappeared by 
putrefaction and the skeleton only remains, or where de- 
tached bones merely have been discovered. 

When the death has but recently occurred and the body 
is unmutilated, most of the same general methods of estab- 
lishing- identity are available as have already been mentioned 
in the case of the living — such as the testimony of relatives 
and acquaintances as to the personal appearance of the de- 
ceased, certain marks upon the person, as nevi, moles, cica- 
trices, tattoo-marks, fractures, deformities, etc. Photographs 
and other portraits are here also admissible, although by no 
means always reliable proofs. 

If the body has been subjected to mutilation after death 
and the several portions removed to a distance from one 
another and some of them even destroyed, as is sometimes 
done by a murderer with a view to escape detection, the 
difficulty of identification is, of course, very much increased. 
Nevertheless, if the disconnected parts can be recovered, 
or even a portion of them, it will always be possible for a 
skilled anatomist so to readjust them as to reconstruct the 
body, so to speak, by making the proper allowances for 
the missing parts and comparing these with other average 
specimens of a similar kind. Several striking examples of 
this character have been recorded. One of these is the 
well-known case of Dr. Parkman, who was murdered by 
Dr. Webster, in Boston, Mass., about forty years ago. After 
the death of his victim Dr. Webster attempted to destroy all 
evidences of the deed by cutting up the body into fragments, 
some of which were burned in a grate, some immersed in 



IDENTIFICATION OF THE DEAD. 69 

chemicals, and others packed away in boxes in distant parts 
of the building. On the discovery of these remains, a week 
after the murder, the portions of the body were accurately 
examined by a skilled anatomist. It was proven that they 
were human remains, belonging to one and the same body ; 
of the male sex; and that they had not been dissected for 
anatomic purposes, but cut and hacked in different direc- 
tions, for the object, evidently, of mutilation. On restoring 
these disjointed parts in situ, and supplying the deficient 
portions, it was found that the proper measurements agreed 
closely with those of the missing Dr. Parkman. This cir- 
cumstance, together with the discovery of certain marks of 
identity about the teeth and jaws (the head had been almost 
completely destroyed by fire), afforded sufficient evidence 
of the personal identity of the missing man to enable the 
jury, on the trial of Dr. Webster, to find a verdict of guilty. 
Another instance of a somewhat similar nature is recorded 
by Professor Taylor. A number of years ago a murder 
was committed in London, on the river Thames, and shortly 
afterward a package containing mutilated human remains 
was discovered on one of the abutments of Waterloo Bridge. 
The murderer had no doubt, intended to throw the bundle 
into the river ; but it had lodged on the projection in its de- 
scent. Dr. Taylor was requested to examine and identify 
these mutilated remains ; and when, after great difficulty, 
the parts were brought together and found to fit, the body 
was identified as that of a man who had recently disappeared 
from a vessel on the river — a Swedish sailor. One of the 
most remarkable cases of this class was tried in Chicago, 
Illinois, in 1897. The defendant, Luetgert, was a sausage- 
maker, and was accused of having murdered his wife and 
destroyed her body by solution in caustic soda in a vat in 



70 MEDICAL JURISPRUDENCE. 

his manufactory. Some small bones and articles of jewelry 
were found in the vat. The trial lasted many days, but 
ended in a disagreement of the jury. The contention of 
the prosecution that the bones found were human was com- 
bated by experts called by the defense. 

When the question of identity relates to the skeleton 
merely, or only to portions thereof, the answer cannot be 
always satisfactory, and the medical jurist has need of much 
caution and reserve before giving a positive opinion. 

The very first thing for him to determine is whether the 
bones submitted to his inspection are human bones or those 
of some of the inferior animals. Doubtless, if the entire 
skeleton be discovered, there need be no uncertainty about 
the matter; but if only a single bone or two be found, a 
mistake may easily be made, except by a practiced anatomist 
and osteologist. Indeed, many ludicrous blunders are re- 
corded of persons, of otherwise good medical education, 
mistaking the bones of the ox, horse, dog, pig, and goat for 
those of the human subject. But may not something be 
learned by the aid of chemistry or the microscope? The 
reply must be generally in the negative. Certainly, the 
bones of the aged do contain more calcareous matter than 
those of the young, and consequently present a somewhat 
different appearance under the microscope. But human 
bones have the same general chemical composition as those 
of the lower animals. Bone-cells or corpuscles vary some- 
what in size in the different orders of animals, being largest 
in reptiles, smallest in birds and mammals, and intermediate 
in fishes. In this respect there is an analogy with the size 
of the blood corpuscles in these different orders ; but these 
are only generalizations, and would be of little practical use 
in individual instances. To be sure, the microscope will 



IDENTIFICATION QF MUTILATED REMAINS. 7 I 

enable us to determine the fact of any specimen submitted 
being- bone, or not, by the presence or absence of the bone- 
cells ; but it can go no further, inasmuch as it cannot dis- 
tinguish the bone-cell of a man from that of a mouse or of 
an elephant. 

If the skull is the only portion of the skeleton submitted 
for examination, there can usually be no difficulty in recog- 
nizing it as human ; the only doubt that might arise would 
be the possibility of its belonging to one of the higher order 
of (anthropoid) apes; but even here there are important 
differences which would not be overlooked by one skilled in 
comparative anatomy and osteology. The further ques- 
tion, whether from the examination of a skull simply, it is 
possible to decide to what race the individual belonged, — 
Caucasian or otherwise, — we do not think can be answered 
with absolute certainty. Doubtless, well-marked typical 
skulls may be identified as belonging to some particular 
race, e. g., the Negro or Caucasian ; but we must remember 
that the points of distinction, which in well-marked speci- 
mens serve to separate these, shade away in many instances 
so as to make it extremely difficult, if not impossible, to 
give a medico-legal opinion in an isolated case. 

Another important point is to ascertain whether all the 
bones submitted for inspection belong to one and the same 
skeleton. The mere fact of their being discovered together 
does by no means necessarily prove it, since they might 
have been so placed either accidentally or with the design 
of eluding detection of some crime. 

In the identification of the dead by means of the skele- 
ton or by detached bones, the three leading points to deter- 
mine are (i) the age, (2) the sex, and (3) the stature. 



72 MEDICAL JURISPRUDENCE. 

I. The Age. — This can generally, in young subjects, be 
pretty accurately determined by the development of the 
teeth and by the progress of ossification in the different 
bones. In the skeletons of new-born children, and before 
the teeth have appeared, it may become important for the 
medical jurist to be able to decide upon the age in order 
either to rebut or confirm a charge of infanticide. It is 
authoritatively stated that in the jaws of a child at full 
term there will always be found the rudiments of twenty- 
four teeth — twenty primary teeth and four permanent 
molars. Hence, if only the jaws of an infant be discovered, 
medical evidence of its probable age may be given. The 
average date of the eruption (cutting) of the teeth is, ac- 
cording to Mr. Bell, as follows : The four central incisors 
appear from five to eight months after birth ; the four lateral 
incisors, from seven to ten months ; the four anterior molars, 
from twelve to sixteen months ; the four cuspidati, from 
fourteen to twenty months ; and the four posterior molars 
from eighteen months to three years. Between six and seven 
years the jaws contain forty-eight teeth — twenty temporary 
ones in a perfect state of development, and twenty-eight 
permanent ones imperfectly developed and placed behind 
the temporary teeth which they are to replace. According to 
Mr. Saunders, the order in which the permanent teeth make 
their appearance is as follows : At seven years, the four 
anterior molars ; at eight years, the four central incisors ; at 
nine years, the four lateral incisors ; at ten years, the four an- 
terior biscuspids ; at eleven, the four posterior bicuspids ; at 
twelve to twelve and a half years, the four cuspids ; and at 
thirteen to fourteen years, the four second molars — making 
the whole number of permanent teeth at this period twenty- 
eight. The four remaining (posterior molars) teeth — called 



DETERMINATION OF THE AGE. 73 

wisdom teeth — do not usually appear until from eighteen to 
twenty-one years of age. As a rule, the teeth of the lower 
jaw are cut first, but there are many exceptions ; nor must 
it be forgotten that irregularities often occur as to the order 
of their appearance. The above description is intended to 
apply only to the average cases. 

To cite one or two examples in illustration of the medico- 
legal application of the foregoing rules: suppose the skull 
of a child was discovered, in the jaws of which were 
twelve permanent teeth — eight incisors and four molars ; we 
should decide the age to be about nine years. If the jaws 
contained twenty-four permanent teeth — eight incisors, four 
molars, eight bicuspids, and four cuspids, we should con- 
clude the age to be about thirteen years ; and so on. It is 
proper here to remark that there are two diseases which 
affect the growth of the teeth, viz., rickets and syphilis. In 
a rickety child the first teeth do not usually appear until 
after the twelfth month, whereas in cases of congenital 
syphilis the teeth appear prematurely — ^before the sixth 
month ; but they present a peculiar notched appearance, and 
they are apt to be brittle and to crumble away easily. 

The progress of ossification in the different bones of 
the skeleton affords an additional test of its age, espe- 
cially in early life. According to Beclard, the degree of 
ossification in the lower epiphysis of the femur affords the 
most certain criterion of the age of the fetus and of the 
new-born child. Thus, if no ossific deposit can be seen in 
this cartilaginous epiphysis, it is certain that the fetus has 
not attained to the eighth month of uterine life. If the 
osseous deposit is as large as a poppy-seed, it is probably 
in the ninth month of fetal existence ; and if it has acquired 
the diameter of a line and a quarter, to one and a half, it 
8 



74 MEDICAL JURISPRUDENCE. 

has reached the full period. If the point of ossification 
measures three lines or more, it may be assumed that the 
child had survived its birth some little time. 

The average length of the skeleton of a new-born child 
is about sixteen inches. At the end of the first year, ossi- 
fication has commenced at the extremities of most of the 
long bones ; and this progressively advances from year to 
year until the whole process is completed, and the epiphyses 
of all the long bones become united to their shafts at full 
maturity, which, in the male, may be considered to be 
twenty-four years, and in the female, twenty-two years. 
After this period, or when ossification is once completed, 
it is difiicult to determine the precise age by an examina- 
tion of the bones of the skeleton. It should, however, be 
remembered that the different bones of the sternum do not 
unite until about the fortieth or forty-fifth year ; and union 
between the sacrum and os coccygis is not usually com- 
pleted .until fifty-five or sixty years of age. 

In old age, the bones become lighter in weight and more 
brittle, from the loss of animal matter. They are also 
darker in color; and the flat bones become thinner, from 
the absorption of the diploe. In the skull of the aged, the 
sutures are more or less obliterated ; and the remaining 
teeth present a worn appearance, and a yellowish color. If 
the teeth have been lost (as is usually the case, at least in 
this country), the alveolar processes become absorbed, and 
the lower jaw undergoes a well-marked change in its appear- 
ance, consisting of the widening of the angle at its neck, and 
the shortening of the vertical diameter of its body, or width, 
which imparts the characteristic senile expression to the 
mouth of the aged. The discovery of such a jawbone 
would positively determine the age to be about seventy 
years or over. 



DETERMINATION OF THE AGE. 75 

The presence or absence of certain teeth in the head has 
frequently been the means of determining the identity of 
the body. So, also, the presence of artificial teeth, with 
their mechanical appendages, has at times furnished the 
strongest corroborative evidence in such identification, as 
in the celebrated Parkman-Webster case, already alluded to, 
in which the artificial teeth, discovered undestroyed by the 
fire in the grate, where the head had been burnt up, were 
positively identified by the dentist who had manufactured 
and fitted them some years before. So, likewise, the remains 
of the Marchioness of Salisbury, discovered among the 
burnt ruins of Hatfield House, were identified by the jaw- 
bone having gold appendages for artificial teeth (Guy). The 
importance of the teeth as a means of identification is shown 
in the case of the late French Prince Imperial, killed in 
battle ; his body had been so much disfigured by his savage 
assailants that its identification would have been extremely 
difficult but for certain peculiarities about his teeth. 

Professor J. W. Pryor has recently published {Bulletin 
of the State College of Kentucky, June, 1905) a study of 
the development of the bones of the hand, from examinations 
made on living subjects by X-rays. The paper is illus- 
trated by photographs. The tests show clearly that the bony 
portion of the hand develops earlier in the female than in 
the male. The difference, noticeable even in very early life, 
becomes more marked as time passes. The full develop- 
ment of a girl's hand is at least two years before that of a 
boy's. Reference must be made to the original paper for 
the details. The following are a few of the interesting 
points. The bones of the carpus were recognized in the fol- 
lowing order : magnum, unciform, cuneiform, semilunar, 
scaphoid, trapezoid, trapezium, pisiform. The magnum was 



'J^ MEDICAL JURISPRUDENCE. 

recognized in a girl not quite four months old ; in a boy not 
quite seven months old. The scaphoid was recognized in a 
girl about four ; in a boy about six. The pisiform was found 
in a girl between nine and ten ; in a boy between twelve and 
thirteen. 

II. The Sex. — This can usually be determined from the 
skeleton, if entire, without much difficulty. The male and 
female skeleton present many well-defined points of differ- 
ence, which are described in all anatomic works. The 
corresponding bones of the two differ in size, weight, 
strength, and prominence of their ridges and protuberances 
which mark the points for the insertion of muscles. There 
are also certain recognized differences in the head and 
thorax; but it is in the pelvis that the most characteristic 
distinctions are observed. The male pelvis is narrower and 
deeper than that of the female. In the latter, the iliac 
bones are more spread out, and flatter, which renders the 
superior part of the pelvis more capacious ; the sacrum is 
broader, and turned more backward; the arch of the pubis 
is much wider. The greatest diameter is the bilateral; 
whereas in the male, the antero-posterior is the greater. 
The foramen ovale is triangular in the female ; in the male, 
it is more oval. Owing to the greater breadth of the female 
pelvis, the acetabula are farther apart than in the male. It 
is to be understood that these peculiarities in the female 
pelvis are not clearly exhibited before the period of puberty. 
From a fragment of a bone it would certainly be hazardous 
to undertake to determine the sex; and care should be 
exercised in giving an opinion in such a case. 

III. The Stature. — If the whole skeleton has been pre- 
served, and none of the ends of the long bones have been 



IDENTIFICATION OF THE STATURE. 7/ 

lost by decay, the original height may be calculated with 
tolerable accuracy by arranging the bones in situ, and adding 
an inch and a half to two inches to the entire length of the 
skeleton, to supply the loss of the soft parts. But even here 
perfect accuracy cannot be attained, chiefly on account of 
variations in the curve of the spinal column in different indi- 
viduals. Dr. Dwight assumes, as the result of numerous 
observations, that the total height of the intervertebral carti- 
lages is 25.6 per cent, of the entire length of the spine. As 
a collateral aid in estimating the stature, we may regard as 
correct the generally accepted rule that the top of the 
symphysis of the pubes is about the center of the body in 
average women ; while in men, the center is a little below 
the symphysis. 

The attempt has frequently been made to estimate the 
height of the body from a study of the individual long bones 
of the skeleton ; but no reliance can be placed upon such com- 
parisons, inasmuch as there is considerable variation in the 
length of these bones in skeletons of the same stature. The 
so-called " rules of proportion " of certain writers cannot 
be regarded as by any means certain or authoritative. In 
case the skull is wanting, the rule laid down by Dr. Gould 
is " to find the height of the spine of the seventh cervical 
vertebra from the ground, and add to this 9.95 inches, which 
is the average height from this point to the top of the head." 
De St. Lucca states that there is a general proportion be- 
tween the different bones of the body and the stature, and 
that an approximate estimate of the stature may be had by 
measuring the length of the first phalanx of the middle 
finger, thus: this phalanx is equal in length to one fourth 
that of the whole hand, including the carpus ; and the carpal 
and metacarpal bones together represent one half of the 



yS MEDICAL JURISPRUDENCE. 

hand. The arm may be divided into five parts, of which two 
were included in the humerus, two in the fore arm, and one 
in the hand. The total length of the hand is, therefore, one 
fifth of the arm. Double the length of the arm (or the two 
arms stretched out horizontally), added to the length of 
the two clavicles, together with the transverse diameter of 
the sternum, is equivalent to the whole length of the body. 
In applying this rule to practice, however, we must not forget 
that the length of the hand, and especially that of the fingers, 
varies materially in persons of the same height ; and so 
trifling a variation in the first phalanx of the middle finger 
as the one sixteenth of an inch would, according to this 
method of calculation, figure up as great a difference in the 
total result, for the height of the whole body, as two and a 
half inches. 

> The existence of fractures, deformities, and callus in a 
skeleton sometimes affords valuable aid in its identification, 
even many years after death. In relation to the produc- 
tion of callus, it is well understood that this substance is 
the result of the reparative processes in bone, and that its 
presence is a certain indication that some time must have 
elapsed between the injury to the bone and the death of 
the individual. On the other hand the total absence of callus 
on a fractured bone, indicating that no time had been given 
for the process of repair, would be very good evidence that 
the injury was the immediate precursor of death, and if on 
the skull, the probable cause of death. An instructive illus- 
tration of this is given by Taylor in the case of an English- 
man, who was tried in India for the murder of a native who 
had been beaten with a stick, the allegation being that a rib 
had been broken, thereby causing his death. To substan- 
tiate this charge, a skeleton was produced which had been 



IDENTIFICATION BY SKELETON. 79 

dug- lip three months subsequent to the decease of the alleged 
murdered man, which was almost completely denuded of 
flesh ; the bones clean and dry ; one rib fractured, with a de- 
posit of callus around the fracture. The identity of these 
bones with those of the missing man was attempted to be 
established by the prosecution, but unsuccessfully, in conse- 
quence of their dry and denuded state — a condition alto- 
gether incompatible with so short a period of time as three 
months since death. Moreover, the amount of callus thrown 
out made it evident that more than a week must have elapsed 
before death took place, which event was alleged to have 
occurred immediately after the injury. 

Other notable instances might be mentioned of the iden- 
tification of the skeleton by means of the above-mentioned 
marks, or peculiarities, and even where it was possible to 
determine the actual cause of the violent death. In the 
year 1823, a soldier living in the south of France suddenly 
disappeared under suspicious circumstances. Two years, 
however, elapsed before any investigation was instituted by 
the proper authorities. Some human bones were then dis- 
covered in digging in the garden of the deceased soldier. 
Of course, it became necessary to identify these remains. 
It was remembered that the deceased had a singular per- 
sonal deformity, in possessing a sixth finger on the right 
hand, and a sixth toe on the left foot. On examination, it 
was ascertained that the fifth metacarpal bone of the right 
hand was shorter and broader than the corresponding bone 
of the other hand, and further, that there were two articu- 
lating surfaces on its digital end, indicating clearly the ex- 
istence of a supernumerary finger. In the same way the 
fifth metatarsal bone of the left foot showed two distinct 
articulating faces on its digital extremity, indicating the 



80 MEDICAL JURISPRUDENCE. 

existence of a supernumerary toe. Besides this, the age, 
sex, and stature of the skeleton corresponded with those 
of the missing man. But even further than this, a close 
inspection of the skull revealed the distinct marks of a de- 
pressed and radiated fracture of the temporal bone, which 
showed no sign of reparation by the formation of callus. 
Evidently, then, death had occurred very soon after the 
fracture of the skull, and in all probability as the direct 
result of violence. Upon this evidence, the suspected par- 
ties were tried and executed, having previously confessed 
their crime. 

Sometimes, on the exhumation of bones, the question 
arises as to how long they have been buried. After all the 
soft parts have disappeared, which commonly requires 
about ten years, it is only possible to give an approximate 
estimate. In a dry soil, bones will resist decomposition 
for thirty or forty years after burial ; and if preserved out 
of the ground, as in the crypts of old churches, they may 
last for hundreds of years. As the process of decay pro- 
gresses they become lighter in weight, in consequence of 
the loss of animal matter, and the color externally grows 
darker. The ends gradually become brittle and crumble 
away, and finally the shaft of the bone undergoes a similar 
disintegration, the mineral matter alone remaining unal- 
tered. Devergie states that the bones of King Dagobert 
were found in a state of tolerable preservation, enclosed in 
a leaden coffin and sarcophagus, at St. Denis, after the 
lapse of twelve hundred years ; and Dr. Taylor mentions 
that the skeleton of William Rufus was found in a stone 
coffin at Winchester nearly perfect, after seven hundred 
and eighty years' burial. The bones of Abelard and 
Heloise were so well preserved that after a lapse of five 



IDENTIFICATION BY SKELETON. 8 1 

hundred years the female skeleton could readily be distin- 
guished from the male. 

Even if the bones have undergone calcination, as when a 
body has been burned with a view of destroying its identity, 
especially in cases of infanticide, it may still be possible to 
determine whether the remains are human, provided the 
bones preserve their proper form and have not been re- 
duced to powder. 

Other means of personal identification are afforded by a 
microscopic examination of the hair and the fibers of various 
sorts of fabrics, such as cotton, wool, and silk. Human 
hair discovered on a weapon, along with blood stains, 
affords strong presumptive evidence of murder or violence. 
So, also, fibers of cotton, or of other material, found on 
weapons supposed to have caused death, or else on the 
person of the accused, suggest a strong suspicion, if these 
fibers correspond to the clothes of the deceased. Thus a 
case is mentioned by Taylor, where the discovery of some 
cotton fibers, accompanied by a blood stain, upon the edge 
of a razor, found near a woman, whose throat had been cut 
while in bed, led to the subsequent detection of the mur- 
derer. In the same manner, the discovery of a few hairs 
upon the handle of a knife, on which also were marks of 
blood, enabled a London microscopist to declare that these 
hairs were squirrel hairs ; which circumstance further led to 
the identification of the murderess of a child, whose throat 
had been cut with a knife, which, in the death wound, had 
passed through a victorine made of squirrel fur worn around 
the child's neck. 

In case of rape, the examination of the hair about the 
female genitals will be likely to show the presence of seminal 
spots and of spermatozoids. 



82 MEDICAL JURISPRUDENCE. 

In all caseSj except when hairs are to be examined for 
spermatozoids, they should be washed in warm water and 
then thoroughly dried, afterward steeped in turpentine and 
finally mounted in Canada balsam. They should then be 
examined with a magnifying power of about 200 diameters. 
To examine hairs for spermatozoids, moisten first of all with 
a drop of ammonium hydroxid solution, and examine under 
a microscope after the liquid has evaporated. 

For the identification of hairs, human or other, it is de- 
sirable to have at hand specimens of various kinds of these, 
properly mounted for comparison. Hairs resist putrefac- 
tion for a long time. It should also be remembered that 
hair is affected differently by different reagents. Strong 
alkalies dissolve it; acids roughen it; alcohol causes it to 
look clearer ; chlorin water bleaches and rots it. 

The size of hairs from different parts of the human body, 
as well as from different individuals, varies considerably; 
thus, the hairs from the head are finer than the eyelashes, 
but coarser than the hairs from the arm. There is also 
considerable difference in the size of the hairs of the various 
lower animals. 

The main medico-legal questions connected with the 
identification of hairs are : ( i ) Is the hair human, and from 
what part of the body? (2) Does it correspond with the 
hair of the murderer or of the victim? (3) Has its color 
been naturally or artificially changed? It should be re- 
membered that gray hair is not infrequently found on com- 
paratively young persons, and that undoubted instances 
have occurred of the sudden bleaching of the hair through 
fright or grief. As regards the artificial coloring of the 
hair, it is well known that this is one of the means of dis- 
guise most commonly adopted by criminals in order to 
elude detection. 



IDENTIFICATION OF HAIRS. 83 

Many common hair dyes for coloring light or red hair 
black or brown, are composed of the salts of lead, silver, or 
bismuth, but organic colors are also used. Colors may 
often be detected by soaking the hair in nitric acid, which 
dissolves out .the mineral, which may then be identified by 
the appropriate tests. It is more difficult to bleach the hair 
than to darken it. This is usually effected by washing it in 
an alkaline solution to remove grease, and then soaking it 
in chlorin water or hydrogen dioxid solution, which will 
lighten the tint in a few hours. Chlorin water renders the 
hair very brittle and imparts an odor to it. 

In all artificially colored hair, the fraud can be detected by 
closely watching the new growth, which will be of a different 
color from the other portions ; and also by chemical tests. 

The fibers of cotton, linen, wool, and silk all present well- 
marked differences when viewed under the microscope. 
The cotton fiber is in the form of a flattened band, with 
thickened borders, and is spiral or twisted upon itself. 
Linen consists of round fibers, having a firm consistency, 
with jointed transverse markings at unequal distances, some- 
what resembling those on the India cane and tapering to 
a point. Silk fiber has the appearance of straight, well- 
defined cylinders, free from all markings and refracting light 
powerfully. Wool fiber is irregular, wavy, and of unequal 
thickness. The fibers of hemp resemble those of flax 
(linen), but are coarse; and when boiled in nitric acid they 
exhibit no spiral streaks, but swell and become brittle. 

The identification of blood stains and seminal spots will 
be treated of later. 



CHAPTER VI. 

CAUSES PRODUCING VIOLENT DEATH. 

The third important question requiring decision in every 
case of violent death is the cause of the death. These 
causes are numerous and diversified, but may be considered 
under the following heads : — 



Wounds. 

Burns and Scalds. 

Suffocation. 

Strangulation. 

Hanging. 



Drowning. 
Electricity. 
Heat and Cold. 
Starvation. 
Poisoning. 



VIOLENT DEATH FROM WOUNDS. 

A wound is a solution of continuity, in any tissue, pro- 
duced by violence. It may be subcutaneous — that is, be- 
neath the skin — or it may be open; further, wounds may 
be superficial or deep ; they may be incised, punctured, 
contused, lacerated, poisoned, gunshot, etc. Penetrating 
wounds enter cavities, but do not emerge ; perforating 
wounds both enter and emerge from the cavity. 

A distinction is sometimes made between mortal and 
non-mortal wounds, or between wounds dangerous and not 
dangerous to life, and the medical witness is asked to give 
an opinion on this subject. He should be guarded in his 
answer, since it is well known that many wounds at first 
considered as comparatively trivial, may assume a danger- 
ous and even fatal character. Of course, in many cases 

84 



WOUNDS A CAUSE OF DEATH. 85 

there would be no difficulty in pronouncing upon the dan- 
gerous or mortal character of a wound ; for instance, 
wounds of the heart or the great vessels or internal viscera, 
or compound fracture of the skull. The danger of a 
wound depends upon many circumstances, all of which 
should be considered, such as : position ; relation to the 
great vessels and nerves ; weapon by which it was inflicted ; 
amount of hemorrhage ; age ; constitution and general 
health of the subject; circumstances (favorable or unfavor- 
able) for treatment. Medical testimony is usually required 
only in case of a fatal termination, except in the case of 
assault, when the character of the injury (whether dan- 
gerous or trivial) might decide as to the propriety of ac- 
cepting bail for the prisoner. 

In case of death from a wound, the medical examiner 
should never theorize as to the manner of its causing the 
death ; and he should give his opinion only after a very 
careful post-mortem examination of the body. Moreover, 
as before mentioned, the examination should not be con- 
fined simply to the wounded portion of the body, but all 
the cavities and organs should be inspected, since it may 
be affirmed that a natural cause of death might have existed 
in that very part which was neglected by the examiner. 
Such neglect has often occasioned a doubt in the minds of 
the jury as to the real cause of death. It may be necessary 
to examine the stomach for poison, as shown by the oft- 
quoted instance recorded by Wildberg, of the girl who was 
beaten by her father for stealing, and who died shortly 
afterward, apparently from the effects of the blows, but 
in whose stomach a considerable quantity of arsenic was 
found. She had swallowed the poison soon after commit- 
ting the theft, fearing her father's anger. The accused was 



86 MEDICAL JURISPRUDENCE. 

discharged. In a similar manner it sometimes happens 
that a person, after taking poison with suicidal intent or 
after stabbing himself through the heart (death not being 
instantaneous), may destroy himself by another means, as 
by a gunshot wound, by drowning, or by throwing himself 
from a window or a precipice. 

The examination of the wound includes the observation 
of its situation, extent, and direction ; the presence or ab- 
sence of effused blood, whether liquid or coagulated, and 
the presence of ecchymoses ; the condition of the edges 
of the wound, whether everted or not; whether adhesion 
has commenced; the presence of granulation, inflammation, 
suppuration, or gangrene; whether it was inflicted before 
or after death ; whether there is loss of substance, or hernia 
of the viscera. The clothes of the deceased should be 
inspected to ascertain if the rents or perforations in them 
correspond with the wounds of the body. If the weapon, 
say a knife, with which the wound is alleged to have been 
made, is at hand, it should not be used in the examination 
or comparison with the wound. Another instrument ex- 
actly like the one in question, or a piece of wood shaped 
like the supposed weapon, may be substituted. The fol- 
lowing recent case is in point: An old man was found 
dead, with his throat cut, and the butcher-knife with which 
the wound was alleged to have been produced was fitted 
into the wound in the neck. Later it was found that this 
particular knife had been used a short time previously by 
the defendant in killing poultry, and he maintained that 
the blood found on it at the inquest was that of a chicken 
or turkey. The microscope afterward showed the presence 
of both mammalian and oviparous blood; but the knife 
having been placed in the wound post-mortem, rendered 



WOUNDS A CAUSE OF DEATH. 8/ 

the evidence adduced by the microscopic examination of 
no value. 

In cases of severe injury it sometimes happens that death 
results from internal lesions, with few or no external marks. 
According to Casper, this is of frequent occurrence in 
severe internal lacerations occasioned by violence. He cites 
an illustrative case: A wagoner, in guiding a team draw- 
ing a loaded wagon down a hill, was accidentally crushed 
against a tree on the road. He was found dead the next 
morning. The only external injuries were a slight abrasion 
upon the left arm, and one upon the right temple. On 
opening the body, however, the most striking evidences of 
violence were discovered. From the spinal canal about a 
quart of blood escaped. The spinous processes of the first 
thoracic vertebrae were broken off. The left pleural cavity 
contained about thirty ounces of fluid blood. The peri- 
cardium was torn completely across ; and the heart, severed 
from its large vessels, lay almost entirely loose in the cavity 
of the thorax. The open ends of the aorta and pulmonary 
artery were distinctly visible. The left lung was entirely 
torn through its middle portion; and in the right lobe of 
the liver was a laceration two inches long and half an inch 
deep. 

The distinction between wounds made before and after 
death must be carefully noted. Wounds inflicted before 
death may be recognized by the following signs : ( i ) Incised 
wounds exhibit everted edges, arising from the elasticity of 
the skin and subjacent muscles, with considerable hemor- 
rhage, usually of an arterial character; spots of arterial 
blood which have spouted on to neighboring surfaces are 
of a peculiar comet-like shape. Coagula are more or less 



88 MEDICAL JURISPRUDENCE. 

abundant in the wound, and around it. The surrounding 
tissues are more or less infiltrated with blood. If some 
days have elapsed before death, evidences of vital reaction 
will be shown, such as partial healing, granulation, suppura- 
tion, or sloughing. If the wound was made immediately 
after death — within a few minutes — there may be some 
retraction of the skin and some slight bleeding, with few 
or no coagula, which are of loose texture. There is little 
or no staining of the surrounding tissues, and never any 
attempt at repair. If the wound be made ten or twelve 
hours after death, there will be no eversion of its edges, no 
hemorrhage, except of a slight venous character, and no 
surrounding infiltration. The experiments of Taylor and 
Aston Key upon amputated limbs confirm the above de- 
scription. The amount of hemorrhage accompanying an 
incised wound affords a pretty good criterion as to whether 
it was inflicted before or after death. Comparatively little 
bleeding, chiefly venous, accompanies wounds made after 
death ; while in the living, the hemorrhage is chiefly arterial. 
In a case of murder reported by Casper, as also in the case 
of Greenacre, in England in 1837, in which the head of the 
victim was severed from the body, the fact that the head 
was completely drained of blood led to the conclusion that 
the decapitation had been done during life, and that there 
must then have been a copious hemorrhage to account for 
the absence of the blood after death. 

(2) In lacerated and contused wounds the distinction is 
not so obvious as in incised wounds. Lacerations are not 
always accompanied by bleeding, but there will always be 
more or less coagula present; and if the person survives a 
few days, there will be evidences of vital reaction, such 
as suppuration and granulation, sloughing or gangrene, 



WOUNDS BEFORE AND AFTER DEATH. 89 

all of which are absent in such wounds inflicted after 
death. 

Contused wounds made during life are chiefly distin- 
guished by the amount of efifused blood in the cellular 
tissue under the skin (ecchymosis). This arises from the 
rupture of small vessels, and is manifested by the well- 
known " black-and-blue " discoloration produced. If the 
effusion of blood is rapid, the spot is dark red at first; 
if slower, the discoloration is deep blue or violet. In some 
cases of even violent contusion, there may be no appear- 
ance of external ecchymosis. Again, it is not always mani- 
fested immediately over the seat of the contusion, but at a 
little distance from it, especially if the surrounding tissue 
is loose. Familiar illustrations of this are afforded in the 
case of a blow over the eye, producing an ecchymosis of 
the lower lid; and of a blow over the lower portion of the 
abdomen being attended with ecchymosis of the scrotum. 
The presence of ecchymoses, then, in cases of contused 
w^ounds, may be regarded as pretty good evidence of the 
ante-mortem character of the injury, while its absence is 
not necessarily an indication that the wound is post- 
mortem. The experiments of Christison upon the dead 
body go to show that if the contusion be made very soon 
after death, and while the body is still warm, the resulting 
appearances strongly resemble those produced by ante- 
mortem contusion — so much so as to be easily mistaken for 
the latter; with this difference, however, that the effusion 
is usually immediately beneath the skin, and not in the 
areolar tissue ; also that there is an absence of coagula 
and of swelling. 

Ecchymosis is usually superficial, and may appear very 
shortly after injury; or it may be deep-seated and not 
9 



90 MEDICAL JURISPRUDENCE. 

visible at all. In some instances it is not manifested until 
after death, as in the case of a man who died from rupture 
of the bladder resulting from the kick of a horse, thirty- 
five hours after the injury ; no discoloration of the abdomen 
was observed until after his death. Neither can the quan- 
tity of blood effused nor the extent of the injury be always 
estimated by the amount of the discoloration. This is well 
illustrated in Casper's case of the wagoner who was crushed 
to death. 

Another important fact relative to ecchymosis is the 
change of color which accompanies them, since this may 
serve to indicate the probable date of the contusion. In 
about twenty-four hours the blue or livid margin of the 
bruises becomes lighter, or of a violet color, which gradu- 
ally changes to green and yellow. During these alterations 
of color the spot may become larger, but the central por- 
tion remains always darker than the margins. The color 
is finally absorbed and entirely disappears. In general, 
the ecchymosis shows itself within twelve hours after the 
contusion ; the violet color within three days ; the green, 
from the fifth to sixth day ; the yellow, from the eighth to 
tenth day; and, in healthy persons, the complete disappear- 
ance of the spot occurs from the twelfth to fourteenth day. 
The changes are more rapid in the young than in the old, 
and depend also on the degree of the contusion. The above 
changes of color never appear in contusions on the' dead, 
which circumstance constitutes another diagnostic mark. 

It is also important not to mistake the ecchymosis pro- 
ceeding from natural causes, such as scurvy, petechia, and 
purpura, for that occasioned by blows. The former may 
usually be distinguished by being confined to the super- 
ficial layers of the skin, and by their presence also on the 



ECCHYMOSIS. 91 

internal mucous membranes, together with the absence of 
swelHng and the fluidity of the blood. 

According to Devcrgie, ecchymoses are often concealed 
on the bodies of the drowned when first they are removed 
from the water, owing to the sodden state of the skin ; they 
may become apparent only after the body has been exposed 
for some days and the water has evaporated. 

(3) In punctured and penetrating wounds, the diagnosis 
between those inflicted before and those produced after 
death is usually not difficult. The former are attended with 
hemorrhage, and often exhibit signs of vital and reparative 
reaction, such as inflammation and suppuration, or gangrene. 
The latter are destitute of all these. For example, a stab 
made into the left ventricle of the heart after death is fol- 
lowed by no hemorrhage. 

Where inspection does not satisfactorily prove the ante- 
mortem characteristics of a wound, the microscope, in the 
absence of advanced decomposition, will be found invalu- 
able. Suitably made sections will show the presence of the 
processes of repair and the dissolution of blood thrown out 
during the injury. In the case of the Commonwealth vs. 
Schmidt, the question of homicide or suicide turned upon 
the age of certain bruises upon the body of the deceased. 
Microscopic examination showed the subcutaneous tissue 
to be far advanced in the process of repair, and positively 
excluded their having been produced a few hours before, or 
immediately preceding death. 

As regards the particular weapon that may have caused 
the wound, it is not always possible for a medical witness 
to give a decided opinion ; but it is desirable, if possible, 
to establish the relation of the injury with its supposed 



92 MEDICAL JURISPRUDENCE. 

cause; thus, an incised wound would naturally be referred 
to a cutting weapon ; a penetrating wound to a pointed one, 
a bullet or missile ; and a contused wound to a blunt instru- 
ment; but caution should be observed in giving an opinion 
on this subject, especially in case of contused wounds. 

Incised wounds are characterized by the regularity and 
evenness of the cut. This usually serves to distinguish 
them from wounds made by glass and crockery ware or 
nails, which are generally irregular and uneven ; but in 
some instances the cuts produced by broken glass or china 
exactly resemble incised wounds. In stabs the shape of 
the wound may often indicate the character of the weapon, 
whether double-edged or not, but when the weapon has 
penetrated obliquely through the tissues, and when these 
have been stretched, the shape of the wound will not exhibit 
this correspondence. So, also, a wound made in parts 
where the skin is wrinkled may suggest the idea of several 
distinct wounds, as in the neck. It must not be overlooked 
that superficial incised wounds may give rise to dangerous 
or even fatal hemorrhage; and, also, that it is not always 
possible, in such cases, to determine the direction of the 
incision — i e., whether made from right to left or the re- 
verse ; and yet, as remarked by Casper, this fact might have 
a most important medico-legal significance in determining 
the question whether the wound, as in cutting the throat, 
was homicidal or self-inflicted. The attendant circum- 
stances, however, might throw some light upon it, such as 
the presence of blood on the right or left hand, or cuts on 
certain parts of the clothing of the deceased. 

Lacerated and contused wounds do not afford the same 
facility for identifying the weapon as incised wounds. From 
simply inspecting them it will not generally be possible to 



LACERATED AND CONTUSED WOUNDS. 93 

indicate the precise weapon or cause. It may, indeed, be 
possible to say that it was not produced by a cutting instru- 
ment; but a blow made by a blunt weapon upon the skull 
or over the zygoma may give rise to a cut which strongly 
resembles an incised wound, though, as a rule, the division 
of the parts is not as straight and regular as in the latter 
and the angles of the wound are less acute. Moreover, in 
the contused wounds there is more or less swelling, and 
extravasation of blood into the adjoining parts ; and, at 
times, the existence of irregular fracture and internal 
hemorrhage. 

In the case of a fatal contused wound of the head, it has 
been judicially decided that it makes no difference as to the 
guilt of the accused whether he produced the death of his 
victim by a direct blow upon the head, or indirectly by 
causing him to fall upon a stone or other hard substance 
which produced the fracture or contusion. 

As before mentioned, rupture of the internal organs — the 
liver, spleen, heart, lungs, and kidneys — is a frequent result 
of contusions. Fracture of the base of the skull is some- 
times caused by severe contusion of the head. Wharton 
and Stille allude to the fact that spontaneous wounds some- 
times occur in the labia and vagina of pregnant women, 
which might give rise to suspicion of assault. Also, that 
in such women accidents of different kinds are frequently 
attended with profuse hemorrhage from the pudenda. 

It is evident from what has been said in reference to the 
difficulty of always connecting a contused wound with the 
precise instrument that caused it, that the witness should 
avoid committing himself upon the question. In some 
instances, however, the shape of the contused wound, espe- 
cially a depressed fracture of the skull, will enable us to 



94 MEDICAL JURISPRUDENCE. 

come to a correct conclusion on the subject. Some years 
ago Dr. Reese was called upon, as an expert, to testify as 
to the probable cause of a depressed fracture of the tem- 
poral bone of a man who had been struck during a general 
fight. The question was whether the injury had been in- 
flicted by the fist merely, as was alleged, or by an instru- 
ment like a loaded cane or billy. From the private confession 
of a comrade of the prisoner there was good reason for 
believing that the latter instrument, in the hands of another 
person, was the real cause of his death. The fractured 
bone was produced in court. The depression was well 
marked, a quarter of an inch deep, exactly corresponding 
to the loaded end of the billy. Radiating fissures (as would 
probably have resulted from a blow of the fist) were not 
seen. The opinion of Dr. Reese, founded on the above facts, 
was that the fatal blow had not been inflicted by a fist, but 
by a billy, but two physicians on the other side opposed this 
view. The judge dexterously solved the mooted question 
by asserting that, in such cases, one expert was about as 
good as another, and inasmuch as in the present trial there 
were two against one, he would decide in favor of the 
majority ; and so he did, and the prisoner (possibly an inno- 
cent man) was convicted and sent to the penitentiary. 

The examination of the clothes of the deceased consti- 
tutes an important part of the physician's duty, as this may 
throw light upon the mode in which the wound had been 
made, from the character of the cuts or stabs observed 
upon them. So, likewise, marks of blood, dirt, grass, or 
other substances on the clothing may afford valuable indi- 
cations in the same direction. The same remark applies to 
fragments of the clothing of either the deceased or the pris- 
oner discovered near the dead body and agreeing with 



EXAMINATION OF THE CLOTHES. 95 

the clothes worn at the time. Contused wounds by blud- 
geons may, however, occasion considerable laceration of 
the muscles, or even severe fractures, without tearing the 
dress. 

Taylor mentions an instructive case, showing the impor- 
tance of comparing the articles of dress with the injuries 
which may have proved fatal. A woman, aged sixty, was 
found one morning dead in her bed. She had been seen in 
her usual health on the previous night. On inspection, 
there were found two indentations in the right parietal 
bone, and a large clot of blood in this situation, beneath the 
skin^ together with a fracture of the bone four inches in 
extent. Beneath the bone on the dura mater were found 
nearly three ounces of clotted blood. On the evening 
before her death she had been suddenly knocked down on 
the public road by a man accidentally running against her. 
She fell heavily on the back of her head, appeared stunned, 
was raised upon her feet, and, after drinking some brandy, 
recovered sufficiently to walk a mile and a half and eat 
supper. There was a suspicion of murder, in this case, 
against a fellow-lodger ; but when the bonnet worn by the 
woman was produced at the inquest, two indentations were 
discovered on the back part of it corresponding to those on 
the skull of the deceased. The indentations on the bonnet, 
moreover, contained dust and dirt, thereby confirming the 
statement of witnesses who had seen her fall, and rendering 
it highly probable that this fall was the real cause of the 
fatal fracture and eflfusion of blood. It also illustrates the 
well-known fact that a person may receive a fracture of the 
skull, ending in eflfusion, which may not prove fatal for 
many hours after the accident, and which may not have 
prevented the individual from walking a considerable dis- 
tance after the injury. 



96 MEDICAL JURISPRUDENCE, 

Was the wound homicidal, suicidal, or accidental? This 
important question cannot always be settled by medical 
testimony alone, though there are many points in which it 
is of the greatest aid. These are as follows : 

1. The Situation of the Wound. — Suicidal wounds are 
usually inflicted upon the most accessible parts of the body, 
such as the head, neck, breast, and abdomen. If by fire- 
arms, the part usually selected is the head (mouth, forehead 
or temple) or over the heart; if by a cutting instrument, 
the throat or heart. The discovery, therefore, of wounds 
on a part of the body difficult to reach by the individual 
himself, as the back, would certainly not be suggestive of 
suicide ; but an exception must be made here as regards 
the insane, who are well known to destroy themselves by 
self-inflicted wounds of the most extraordinary character 
on the back of the head and neck, by striking the head 
against some solid substance, or by precipitating themselves 
from a height. An insane person (as also the sane) has 
been known to shoot himself with a pistol fired from behind 
the ear. The situation of the \v^ound is, therefore, only 
suggestive of its origin, since it is quite possible that an 
assassin might inflict a death wound upon his victim in such 
a situation designedly, in order to deceive, and thus elude 
the suspicion of homicide. Accidental wounds are usually 
met with on exposed parts of the body. 

2. Nature and Extent of the Wound. — Suicide is rarely 
inflicted by contused wounds, but usually by incised or 
penetrating ones. Exceptions occur, as when a person 
throws himself out of a window or from a height; and, 
in some remarkable instances of self-destruction in the in- 
sane, by butting the head against a wall, and subsequently 
chopping it with a hatchet. In the case of the insane, 



DIRECTION OF THE WOUND. 97 

there is no accounting for the variety in the nature and 
extent of the wounds inflicted for the purpose of self- 
destruction. This fact ought to be remembered, since, if 
the bodies of such persons should afterward be discovered, 
and nothing be known of their previous histories, serious 
errors in relation to the real origin of the wounds might 
result. 

Incised wounds of the throat are often regarded as indi- 
cating suicide ; but it is well known that murderers fre- 
quently destroy their victims by cutting their throats. As 
to the extent of the wound, it is commonly supposed that a 
suicidal incision of the throat does not reach as deeply as 
a homicidal one of the same character ; but instances are 
not wanting where a determined suicide has severed the 
throat down to the vertebrae. Again, irregularity in the 
cut of the throat has been deemed by some as indicating 
homicide rather than suicide, under the idea of resistance 
on the part of the victim ; but it is evident that the irregu- 
larity might have resulted equally from nervousness or in- 
decision in inflicting the wound on the part of the deceased. 

The nature and extent of the wound or injury may serve 
to distinguish accident from homicide. Thus, if numerous 
wounds or bruises are discovered in opposite sides of a 
dead body, the presumption would be in favor of homicide ; 
and when the accused attempts to ascribe the death of his 
victim to a fall, the nature of the wounds might be such as 
positively to contradict his assertions. 

3. Direction of the Wound. — This will often enable us to 
distinguish between a homicidal and an accidental wound 
rather than to decide upon its suicidal character. Thus, if 
death has occurred from a stab, inflicted downward from 
the upper part of the thorax and penetrating the heart, as 
10 



98 MEDICAL JURISPRUDENCE. 

did happen in a certain case, and it was attempted on the 
part of the prisoner to show that the wound had been acci- 
dentally occasioned by the deceased falling, while drunk, 
downward upon the knife which the prisoner had held in 
his hand sloping upward, the downward direction of the 
wound would prove the falsity of the statement. Two 
other cases may be quoted from Wharton and Stille of a 
similar character. One is that of a man discovered dead, 
with a deeply-punctured wound of the neck, which, on 
examination, showed that the weapon had been partially 
turned and withdrawn, and again plunged into the neck in 
a different direction, after the manner of the German 
butchers. This circumstance proved not only that the 
death was not accidental, nor probably suicidal, but pointed 
to a homicide, and also indicated the occupation of the 
murderer. The other occurred in England, some years 
since, where a murder was fixed upon a man from the fact 
that the wound in the neck of the deceased had been evi- 
dently made by a knife cutting from within outward, as is 
done in slaughtering sheep. 

In most suicidal wounds of the throat it is found that 
the cut has been made from left to right ; in punctured 
wounds the direction is commonly from right to left and 
downward. In left-handed persons the direction would, of 
course, be the reverse. These facts, however, can only 
afford moderate presumptive evidence, since it is obvious 
that a murderer might inflict an incised wound in the throat 
of his victim from behind, which would exactly resemble 
that made by the suicide. In all such doubtful cases par- 
ticular attention should be directed to the surrounding 
circumstances, such as the position of the body and the 
weapon, the presence or absence of blood upon the hands 



POSITION OF THE BODY. 99 

and person of the deceased, etc. If the death has been 
very sudden, from hemorrhage (in a case of suicide), the 
weapon will most probably have fallen from the hand, on 
account of the relaxation of the muscles ; but if it has been 
caused by pistol, the weapon may be found tightly 
grasped in the hand of the deceased. If the throat has 
been cut suicidally, blood will be found on one or other of 
the hands ; but if homicidally, and no resistance has been 
made, the hands will probably be unstained. As regards 
the position of the body, if the death be very sudden, from 
loss of blood, the body will be found lying on the back; if 
less sudden, the face and trunk will be turned toward the 
ground. If the body be found upon the back, in death 
from hemorrhage, and the weapon at a distance from it, the 
act was, in all probability, homicidal. 

The position of the weapon in relation to the dead body, 
although at times strongly suggestive, can never afford 
absolute evidence as regards the question of homicide or 
suicide. Thus, Casper mentions the case of a man who cut 
his throat with a razor, which was found bloody and closed, 
two feet distant from the body. Also, of another suicide 
by a pistol-shot in the breast, where the pistol was found in 
the pocket of the deceased, who had afterward terminated 
his life by drowning himself. 

From what has been said above, it is manifest that the 
witness can rarely venture to give a positive opinion as to 
the homicidal, suicidal, or accidental cause of death, apart 
from a consideration of the circumstances accompanying it. 
These circumstances vary in every case, and it requires the 
utmost experience and tact on the part of the medical 
examiner to recognize and apply them in each individual 
instance. Some of them have already been noted: they 

-ore 



lOO MEDICAL JURISPRUDENCE. 

include the position of the body and the weapon; the con- 
dition of the ground where the wound was inflicted; the 
presence of footprints ; the condition of the clothing of the 
deceased; the condition of the hands, whether showing 
wounds or cuts on their palms (indicating resistance), or 
the hands holding portions of hair or fragments of the 
assailant's clothes ; the adherence of certain fibers to a 
weapon, such as cotton, woolen, linen, silk, or fur; marks 
of blood upon clothing or furniture ; state of the mouth 
and throat; marks of blood or other matters on the person 
of the assailant; rifling of the pockets and tearing of the 
dress, etc. These cannot be further enlarged upon here ; 
but their medico-legal importance cannot be too strongly 
enforced. 

When two distinct wounds are found upon a dead body, 
either of which is sufficient to have caused death, the ques- 
tion may arise whether this was a case of suicide or homi- 
cide. Is it possible for a person to inflict upon himself, 
consecutively, two mortal wounds, say by shooting one 
bullet through his brain, and another immediately afterward 
through his heart ? 

There can be, it seems, no question about the possibility 
of the self-infliction of two mortal wounds, provided the 
first one was not instantaneously fatal. It is well known 
that a stab or bullet through the heart or a pistol-shot 
through the brain is not immediately fatal, so that ample 
time is allowed for the repetition of the fatal act on the part 
of the suicide. 

Moreover, it is within the bounds of possibility that, 
after the first fatal shot from a self-cocking pistol, a second 
discharge from the weapon may have been a mere auto- 
matic act — the victim's finger being at the time on the 



GUNSHOT WOUNDS. 10 1 

trigger and thus producing the discharge unconsciously. 
It might even happen that this second unconscious and 
chance shot might produce a fatal wound upon another 
person, and thus give rise to the question of an intentional 
or accidental homicide. 

Gunshot wounds differ from other wounds chiefly in 
the fact that the vitality of the part struck is lost, and that 
there is a consequent slough or loss of substance. They 
are dangerous to life on account of their involving vital 
portions of the body, death occurring either from hemor- 
rhage or from shock to the nervous system. The hem- 
orrhage is seldom great, except when large vessels are 
wounded. Often, from the form of the wound, there may 
be but little external bleeding, while a fatal internal hemor- 
rhage may be going on. They differ much in appearance, 
according to the distance from which the piece was fired, 
and the nature of the projectiles. If the explosion occurs in 
close contact with the body, usually less than nineteen inches, 
the wound is large and circular, the skin denuded, blackened, 
and burned by the half-consumed grains of powder. The 
hair and clothes also in the vicinity of the wound are more 
or less scorched. It may be of vital importance to deter- 
mine the position in which the revolver was held. The 
following points will serve if powder-burns are present: 
The wound of entrance is not in the center of the powder- 
burn, there being a very much greater zone of powder- 
mark at that area of the burn which coincides with the cock 
or hammer side of the pistol ; e. g., if the cock or hammer 
be upward, the most of the powder-burn will be upward, 
and whichever meridian of the powder-burn shows the 
greater quantity of powder, marks the direction of the cock 
or hammer. The entrance orifice of the ball is livid and 



I02 MEDICAL JURISPRUDENCE. 

depressed, and is larger than the point of exit. When the 
piece is fired from a distance, the blackened and burned 
appearance of the skin is not seen, but only the mark of 
the entrance of the missile, and sometimes that of the exit. 
The aperture of entrance of the ball when fired from a dis- 
tance is, according to most authorities, always smaller than 
that of exit. Nealton says that when the wound is recent, 
the entrance orifice is depressed and contused, while the 
exit aperture is lacerated and everted. In the former, there 
is an actual loss of substance ; in the latter, there is merely 
a solution of continuity. After some days, however, the 
contused margins of the entrance wound slough away, 
thereby enlarging the orifice, while those of the exit par- 
tially adhere, causing the latter wound to appear smaller 
than the former,. Casper declares that the entrance aperture 
is always the larger. Very possibly this discrepancy of 
views may arise from not distinguishing between the early 
and the later stages of the two orifices. If the ball enters 
a very fat portion of the body, this often protrudes between 
the edges of the wound and completely changes its appear- 
ance. Again, the character of the entrance will depend 
very much upon the nature of the projectile and its veloc- 
ity, as well as the distance from which it was fired. If the 
ball is conoidal, and traveling with great speed, the wound 
is linear and resembles a puncture producing little external 
harm, but causing very considerable internal injury. A 
rifle-ball makes a large and ragged wound, caused by the 
spiral direction given to the missile. It is evident that 
several wounds may be made by a single ball, as this may 
chance to traverse different parts of the body and limbs. It 
may also happen that the piece may have been loaded with 
two or more balls, which may account for the number of 
the wounds. 



GUNSHOT WOUNDS. IO3 

The deflection of a ball from its straight or direct course 
after entering the body is easily produced by its striking 
obliquely against any resisting surface, such as a bone, 
tendon, aponeurosis, or even muscle. In this way it often 
happens that a ball, striking the chest or abdomen, may be 
caused to pass almost entirely around the body, and after- 
ward be extracted close by the entrance point. Wharton 
and Stille relate the case of a wound by a ball striking on 
the larynx obliquely, and passing around the neck so as to 
lodge on the opposite side of the thyroid cartilage. It was 
thence removed by simply cutting through the skin. It is 
not uncommon for a ball to travel half way around the 
chest or abdomen and lodge in the back, giving the appear- 
ance of having passed directly through the lungs or intes- 
tines. 

If the wound be caused by a load of shot, its appearance 
will depend chiefly on the distance from which it was dis- 
charged. If fired very near the body, so as to enter it as a 
single charge before separating, it will produce a single 
large and ragged wound, much contused and blackened by 
the powder ; and as the shot diverge after entering the 
body there will be considerable laceration of the parts 
beneath. For the opening to be single, the experiments of 
Dr. Lachese, of Antwerp, indicate that the charge should 
not be fired at a greater distance than ten to twelve inches, 
although this is undoubtedly influenced as much by the 
construction of the barrel and the charge as by distance up 
to twenty or thirty inches. When the distance is so ex- 
tended as to allow the scattering of the shot, each grain 
will make its own individual wound. It is quite possible 
for a single shot to cause a mortal wound, as when it hap- 
pens to strike the heart or aorta. 



I04 MEDICAL JURISPRUDENCE. 

The newly-invented forms of small arms, most of which 
throw bullets at very high velocity and are efficient at long 
range, produce wounds that are somewhat different from 
those made by the older weapons. These weapons often 
make cleaner cuts than the older forms. The fatality is 
said to be less with the recent weapons, but this is evidently 
influenced by the modern methods of treatment. 

Wounds made by the wadding and gunpowder alone may 
prove serious or even fatal. A pistol thus loaded, fired at 
twelve inches, tore the clothes and abraded the skin without 
penetrating it ; at half this distance the wadding penetrated 
to the depth of half an inch ; at two inches it entered to 
the depth of two inches, causing a ragged and blackened 
wound; and at one and a half inches the wadding entered 
the thorax between the ribs, and in one experiment carried 
away a portion of the rib. Taylor mentions an instance of 
a man sitting in the gallery of a theater, who had a part of 
his hand completely blown away by a piece of greased news- 
paper, tightly rammed, discharged from a small cannon on 
the stage of the theater. 

Even gunpowder alone is capable of producing very 
serious wounds, if fired close to an exposed part of the 
body. The wound will present a lacerated appearance, and 
be blackened and burned by the partially consumed powder. 
If the grain of powder be coarse, the wound may have the 
appearance of having been caused by very small shot. 

The question of the homicidal, suicidal, or accidental 
character of gunshot wounds must generally be settled by 
the appearance of the wounds, and also by the particular 
circumstances. Thus, if it be on the forehead or temple, 
behind the ear, in the mouth, or over the heart, and if it 



GUNSHOT WOUNDS. IO5 

be blackened or lacerated (indicating the close proximity 
of the weapon), it may be regarded as almost certaintly a 
suicidal act. If, on the contrary, the wound be on the back 
or side of the head (except in the case of the insane), or of 
the body, without the blackened and lacerated appearance 
above alluded to, it may be considered as the act of a 
homicide. Accidental gunshot wounds bear the marks of 
near wounds, as they are mostly the result of the accidental 
discharge of the piece, either in the hands of the deceased 
at the time, or else in close proximity to his person. The 
possibility of a bullet glancing from a hard surface, and 
thus entering a point at which the weapon was not aimed, 
must not be overlooked. 

Out of 368 cases of suicide by firearms, in France, 297 
were from wounds in the head ; of these, 234 were fired 
into the mouth ; only 71 were from wounds inflicted on the 
chest or abdomen. 

In a medico-legal case it may become important to ascer- 
tain the real cause of death occasioned by a wound — 
whether immediate, or from hemorrhage or shock, or re- 
mote, resulting from subsequent complications. In a trial, 
this question might have an important bearing, since, if the 
cause of the death could be shown to have been remote, this 
might involve certain contingencies, for which the prisoner 
might not be responsible. 

When the death is directly traceable to hemorrhage, its 
rapidity depends upon the amount and suddenness of the 
bleeding; and this again is dependent on the size and 
nature of the vessel wounded. Exhaustion follows much 
more rapidly from a sudden hemorrhage than from a more 
copious flow of blood, if gradually lost. Again, arterial 
hemorrhage is more rapidly fatal than venous. It should 



I06 MEDICAL JURISPRUDENCE. 

also be remembered that some persons have a constitutional 
tendency to bleed very easily from the slightest superficial 
wound. Such a tendency, termed a hemorrhagic diathesis, 
is sometimes hereditary, and exposes the individual to great 
danger, in case of being wounded. This circumstance 
might also have weight in the trial. Age and disease also 
increase the danger of death by hemorrhage from wounds. 

Internal hemorrhage, as the result of a wound, is often 
as fatal as the external ; the danger is here further increased 
by the pressure exerted by the effused blood upon a vital 
organ, such as the brain, as is witnessed in effusion of blood 
within the cranium, produced by a fracture of the skull. It 
is also exemplified in a wound of the intercostal arteries, 
causing effusion of blood into the chest, and producing fatal 
pressure on the lungs ; and also in wounds of the throat, 
resulting in asphyxia, from the flow of the blood into the 
windpipe. 

Shock is the result of a violent impression made on the 
nerve centers. It often is the immediate cause of death, 
after a severe injury, without leaving any trace or lesion 
discoverable on a post-mortem examination. Shock is 
most apt to follow extensive lacerations of the body, such 
as result from machinery or railway accidents, or from ex- 
tensive burns. 

The remote causes of death from wounds are numerous 
and varied. The following may be regarded as the most 
common : 

I. Tetanus or Lockjaw. — This is generally the result of 
lacerated and punctured wounds, and is now known to 
be due to the introduction of a specific bacillus into the 
tissues. It is always a serious complication, and is mostly 
fatal. It does not usually appear before the seventh day 



CAUSES OF DEATH FROM WOUNDS. 10/ 

after the receipt of the wound, though sometimes earher, 
and rarely later than the twentieth day. Tetanus is a fre- 
quent result of slight wounds of the hand and face by toy 
pistols and small cannon. The manner of infection is not 
known. 

2. Erysipelas is another complication of wounds, which 
may cause a fatal issue. It is apt to accompany wounds 
of the scalp ; and it sometimes assumes an epidemic char- 
acter, especially in hospitals, where it may occasion great 
mortality among the wounded patients. 

3. Hospital gangrene is another occasional result of 
wounds. It, likewise, often proves fatal, and may assume 
an epidemic type. It is, however, rarely seen except in 
military hospitals. 

4. Surgical Interference, Including the Use of Anes- 
thetics. — In wounds dangerous to life, the. question of the 
propriety of a surgical operation becomes paramount ; the 
patient will certainly die without the operation, and, on the 
other hand, he may die from shock as the immediate result 
of the operation. The question of the legal responsibility 
of the death then becomes a serious one, and, in a trial, 
counsel may endeavor to show that the death was not really 
the result of the wound, but rather owing to the surgical 
operation. Such an argument will not likely avail, unless 
it can be proved that the original wound was not of a dan- 
gerous character, and that the surgical interference was 
unwarrantable and unskillful. The same remarks will apply 
to the use of anesthetics. Their employment in operations 
has now become so general that the occasional fatal results 
attending their administration should be regarded as ex- 
ceptions, in nowise inculpating the attending surgeon ; con- 
sequently, the fatal result that might happen to follow their 



I08 MEDICAL JURISPRUDENCE. 

use should not be considered as offering any extenuation 
if a dangerous or fatal wound has been inflicted. The 
only medico-legal point at issue would be — Was the admin- 
istration of the anesthetic a necessary and proper part of 
the treatment, and was it skillfully administered? 

The question of the responsibility of the surgeon in not 
employing the antiseptic method will be discussed later, 
under Malpractice. 

It will be proper to devote a brief consideration to the 
subject of Wounds in different regions of the body, inas- 
much as these present certain individual peculiarities, which 
give to them special medico-legal importance. 

Wounds of the Head. — Scalp wounds are not usually 
attended with danger, except when followed by erysipelas, 
or when the blow has been so severe as to produce concus- 
sion of the brain. Fracture of the skull may exist without 
any wound of the scalp ; and fatal effusion of blood upon 
the brain may be produced by a blow on the head, without 
causing either a visible wound of the scalp or a fracture of 
the skull. 

Concussion of the Brain may result either from a direct 
blow upon the head, or from a violent fall upon the feet or 
buttocks. Sometimes death ensues immediately from con- 
cussion, leaving no perceptible lesion. Such fatal concus- 
sion may occur without either fracture of the skull or a 
wound of the scalp. The symptoms of concussion are faint- 
ness, nausea, vomiting, pallor, feeble pulse, partial or com- 
plete loss of consciousness, with confusion of ideas and 
tendency to sleep. Concussion may be confounded with 
intoxication, compression of the brain, opium poisoning, sun- 
stroke, etc. 

It is particularly important to distinguish between con- 



SURGICAL INTERFERENCE. IO9 

ciission and intoxication. Many cases of supposed drunk- 
ards, arrested in large cities at night, and left unattended in 
the station-house till morning, are, in reality, cases of con- 
cussion or compression of the brain, which may prove fatal 
for want of timely relief. Difficulty of diagnosis is increased 
by the fact that the two conditions are frequently coinci- 
dent in the same individual. It is the drunken man who is 
/ most apt to engage in a brawl, which results in a broken 
head. Generally, the history of the case (if it can be 
obtained) and the odor of the breath will afford us the best 
means of diagnosis. In intoxication, the temperature is 
usually below 96° F., — sometimes below 90° ; the loss of 
power and sensation is not unilateral, as in compression; 
the bladder is generally full of limpid urine, which will fur- 
nish evidence of the presence of alcohol. The pupils are 
sometimes contracted and at other times dilated. 

Fracture of the Skull is the result either of a direct blow 
or a fall upon the head, striking a stone or other hard body. 
The usual consequence of such a fracture is pressure on 
the brain by the depressed bone or by extravasated blood. 
Fracture of the base of the skull is nearly always fatal, and 
unless carefully looked for in the autopsy, may escape 
notice. It may result from a fall or jump, the person land- 
ing on his feet or buttocks, and be, therefore, unattended by 
any injury of the scalp or face ; such cases not uncommonly 
escape notice in carelessly conducted post-mortems. 

Compression of the Brain may result either from effusion 
of blood or serum upon or within the brain, with or without 
fracture or depression of the bone; also from suppuration 
or tumors in the brain, from congestion of the cerebral 
vessels, and, likewise, from narcotic poisoning. The symp- 
toms are essentially those of apoplexy, viz., loss of con- 



110 MEDICAL JURISPRUDENCE. 

sciousness, paralysis (usually hemiplegic), dilated pupils 
(except where the effusion is on the pons Varolii, when, 
according to Wilks, the pupils are contracted), stertorous 
breathing, a full, slow pulse, and coma. It is important to 
remember that the effusion of blood resulting from a blow 
may be gradual, so that the person seemingly recovers from 
the first shock, and may be able even to resume his ordi- 
nary occupation for some hours, or even days, before the 
fatal termination occurs. The distinction between the 
effusion from violence, and that resulting from disease, is, as 
a rule, that in the former the extravasation is nearly always 
between the skull and the dura mater, or between this mem- 
brane and the brain, while in the latter it is usually in the 
brain substance. Moreover, in the first there is frequently 
a fracture of the bone and ecchymosis of the scalp, either 
immediately over the effusion or on the opposite side of the 
head ( counter-stroke ) . 

Another important point is that a fatal effusion of blood 
may take place simply from great excitement, especially if 
associated with intoxication. This may be urged as the 
probable cause of death where there has been an assault by 
a blow upon the head which terminated fatally. In such 
a case it may be difficult to decide how far the fatal effusion 
was due to natural causes, such as atheroma of the cerebral 
arteries (which, in a habitual spirit-drinker, might also be 
connected with diseased liver and kidneys), or how far it 
was to be attributable directly to the effects of violence. 
However, if the assault can be clearly proven, either in 
connection with a direct blow upon the head, or, indirectly, 
by a fall upon a stone or other hard body, the mere fact of 
the preexisting disease of the arteries or the other organs 
should not lead to the view that the violence had no relation 



COMPRESSION OF THE BRAIN. 1 I I 

to the fatal result ; but if the autopsy show that the efifused 
clot, or serum, was of older date than the alleged injury, 
this would certainly be a strong argument for regarding the 
death as due to the diseased condition. 

Wounds of the substance of the Brain are not always fatal. 
It is well known that considerable portions of the cerebral 
substance have escaped through the skull, not only without 
loss of life, but without serious discernible impairment of 
the mental powers. 

Wounds of the Face are not usually dangerous unless they 
involve the orbit; a penetrating wound of this part may 
readily reach the brain, with a fatal result. So, also, a 
severe blow upon the nose may so injure the ethmoid bone 
as subsequently to involve the brain. 

Wounds of the Neck are attended with much danger, 
owing to the presence of the large vessels and nerves. In 
cut throats, the great danger arises from the sudden and 
profuse hemorrhage. The section of the larynx and trachea 
is not necessarily fatal, the chief danger arising from suffo- 
cation from the flowing back of the blood. A division of 
the esophagus is almost necessarily fatal, chiefly because of 
its involving the section of the great vessels of the neck. 

Wounds of the Spine are dangerous in proportion to the 
degree in which the spinal marrow is involved. In concus- 
sion of the spine, death sometimes takes place instantly. If 
the spinal cord be wounded high up, above the region of 
the phrenic nerve, the function of respiration is immediately 
arrested, and death ensues. Wherever the injury occurs 
to the spinal cord, it is understood that there is a complete 
suspension of the functions of the parts below. In fracture 
of the vertebrae, the great danger arises from pressure on 
the spinal marrow. Sudden death has been produced by 



112 MEDICAL JURISPRUDENCE. 

the spontaneous luxation of the second cervical vertebra, 
arising from the fracture of the odontoid process, through 
disease. Sir Astley Cooper's case was of this character. 
These fractures have an important medico-legal bearing. 

Wounds of the Chest. — The great danger here lies in the 
hemorrhage from the heart, great vessels, and lungs ; hence, 
such wounds often prove rapidly fatal. The hemorrhage 
in wounds of the chest is nearly always internal. Wounds 
of the lungs, though they may not prove immediately fatal, 
frequently so terminate after a lapse of time; this is espe- 
cially true of gunshot wounds, if the bullet or other foreign 
substance happens to be retained. Wounds of the Heart, 
if the cavities be penetrated, always terminate fatally and 
rapidly. Gunshot wounds of the heart do not necessarily 
cause immediate death ; cases are recorded where the patient 
survived several months ; after death the ball has been found 
in the substance of the organ. Even where the cavities of 
the heart have been perforated by a cutting instrument, 
there have been instances where the person survived for 
several days. Rupture of the heart may be the result of a 
violent blow upon the thorax, or it may follow any intense 
excitement, exertion, or emotion, if this organ happens to 
be in a diseased condition. Where death has resulted in a 
brawl in which the deceased received a severe blow on the 
chest, if the preexisting disease of the organ can be estab- 
lished, it would be a question how far the violence and how 
far the disease was to be credited with the result. The 
case is very similar to the one where death follows a blow 
upon the head, terminating in compression of the brain, 
and where a diseased condition of the cerebral vessels 
existed. 

Wounds of the Abdomen. — Even a superficial wound of 



WOUNDS OF THE SPINE. II3 

the abdomen may prove fatal by dividing the epigastric 
artery. A severe blow upon the epigastric region has fre- 
quently produced immediate death, by action upon the 
solar plexus of nerves. Blows upon any part of the abdo- 
men may be followed by peritoneal inflammation, which 
often proves fatal. Penetrating or perforating wounds may 
terminate fatally from the same cause. Wounds of the 
stomach and intestines, though more satisfactorily treated 
of late years by the improved antiseptic methods, are dan- 
gerous and often fatal, either from hemorrhage or inflam- 
mation or both. 

Wounds of the Liver are dangerous, according to their 
extent and depth. If the gall-bladder is involved, death is 
apt to ensue in consequence of the peritonitis. The danger 
from Wounds of the Kidneys arises from the effusion of 
urine, and the consequent inflammation. 

In relation to Wounds of the Bladder, it should be re- 
membered that this organ may be ruptured spontaneously 
from over-distention. It is sometimes ruptured by a blow 
or kick of a horse upon the lower part of the abdomen. 
In a case of death produced by rupture of the bladder, it 
might be sought to set up the plea of spontaneous rupture 
of the organ. Frequently there is no external injury to 
indicate the true nature of the case, the autopsy alone re- 
vealing it, and disclosing, also, extensive peritoneal inflam- 
mation, resulting from the escape of urine. 

Wounds of the Genital Organs are, in the male, usually 
self-inflicted, and they are met with most generally among 
the insane. They comprise castration, more or less com- 
plete, and amputation of the penis, partial or entire. The 
danger to life is great in proportion to the hemorrhage and 
injury to the organs. In certain other cases, where the 
II 



114 MEDICAL JURISPRUDENCE. 

injury has been inflicted by others, and when in a state of 
erection, the urethra has been found violently torn across, 
and the corpora cavernosa and spongiosa divided. In fe- 
males, the chief point of medico-legal interest is to discrimi- 
nate between wounds of the genitals inflicted by another, and 
spontaneous hemorrhages from a ruptured vein in the labia. 
Here, of course, a rigid inspection of the injured parts will 
be needed. 

Examination of Blood Stains. — The identification of 
blood stains not infrequently constitutes a most important 
link in the chain of evidence in a trial for homicide. It is a 
very common practice for a murderer to attribute certain 
suspicious red stains discovered upon his garments or imple- 
ments, to spots of red paint, fruit stains, or to the blood 
of some domestic animal or bird. 

To the naked eye blood stains will vary in size, shape, 
and color. They may be mere films or smears, but gener- 
ally present the form of distinct spots of different sizes ; and 
if the blood has spurted from an artery obliquely upon a 
surface, the spots will have assumed a comet-like shape, 
terminating in a bulbous tail. The color of the stain will 
depend : ( i ) Upon its freshness : if recent, it will have a 
bright red hue ; if old, the color will be brownish, or brown 
red. (2) Upon its thickness; being darker in proportion to 
the density of the stain. (3) Upon the material on which it 
has fallen : if the latter is porous, as soft wood, or linen, or 
cotton fabrics, the tint will be rather dull ; but if on polished 
and hard substances, such as metals, glass, or polished 
wood, the spots have a darker and shining appearance, and 
on drying they are apt to crack from the center, and may 
thus be easily removed. When dried upon linen or cotton, 



CHEMICAL TESTS FOR BLOOD. I I 5 

they usually have a stiffened feel, like a spot of dried albu- 
min or gum. If the stains be upon a colored substance, 
they can best be distinguished by artificial light; indeed, 
they may be entirely invisible in bright daylight. While it 
is not always possible to even proximate the age of a blood 
stain, conclusions of great value may be drawn from a care- 
ful examination. If a clot or stain has been worn it will be 
polished, not uncommonly, greasy, and intermixed with 
dirt. If it is old and unworn, it may be dry and fragile ; 
unless mixed w^ith dirt and grease recent clots are flexible 
and fracture with difficulty. 

We possess several methods of identifying blood stains : 
(i) the chemical; (2) the microscopic; (3) the spectro- 
scopic. But previously to employing these methods, it will 
be always proper to examine the suspected spot, if not too 
much covered with dirt, with a good magnifier ; the spot, if 
a blood stain, will frequently exhibit minute coagula or 
clots of a shiny hue, intermixed with the fibers of the ma- 
terial on which it is fixed. 

I. The Chemical Tests. — Before noticing these, it will 
be proper to remark briefly on the solubility of the coloring 
matter of blood. Modern research has shown that the col- 
oring matter of blood (hemoglobin) when quite recent, is 
very soluble in cold water ; but when so old as to have 
changed to a brown color, it is converted into hematin, 
which is insoluble in water. This is a fact of considerable 
importance. For if a garment or other article is washed 
in cold water immediately after being stained with blood, 
the blood will probably be discharged so as to leave no 
trace; but if the garment be kept for some time before the 
attempt is made to remove the stain by washing, the soluble 



Il6 MEDICAL JURISPRUDENCE. 

hemoglobin will have become more or less associated with 
the insoluble hematin, and enough of the blood will remain 
upon the article to suffice for future identification. Hot 
water will not remove a recent blood stain as effectually as 
cold water, on account of the action of the heat upon the 
hemoglobin, changing it into hematin. 

If the blood-spot be recent, and there be sufficient ma- 
terial, the examiner should cut out a small piece of the 
stained fabric, and suspend it by means of a thread in a 
test-tube containing cold distilled water. In a few minutes 
the coloring matter will be observed to separate from the 
material and to descend to the bottom of the water, form- 
ing a bright-red solution. If the stain is a little older, more 
time will be required to effect the solution, which will have 
a browner hue ; and if the stain is very old, there will be 
no solution whatever. 

If the stain be upon a porous substance, such as wood, 
brick, etc., it should be cut or scraped out, reduced to 
powder, and then soaked in cold water for some hours and 
afterward filtered. If the spot be upon a hard metallic sur- 
face, as a knife, sword, etc., it should be carefully dried, 
when it will be apt to crack off; if not, it may be scraped 
off with a knife. The scraping should be soaked for some 
time in cold water and filtered. If the solution should not 
be complete, a little dilute ammonium hydroxid may be 
added, and, if this should fail. Tidy recommends using a 
trace of citric acid to effect the solution. 

Having procured the clear red solution, the next step is 
to heat it in a test-tube over a spirit lamp ; the following 
results are thus obtained : ( i ) the red color disappears ; 
(2) coagulation takes place; (3) a brownish-green precipi- 
tate is formed. If there is sufficient quantity of this pre- 



CHEMICAL TESTS FOR BLOOD. II7 

cipitate, it may be collected, dried, and heated with a weak 
ammoniuni hydroxid solution, which will dissolve it ; the 
solution will appear dark green by reflected and red by 
transmitted light. (4) Dilute ammonium hydroxid added 
to the original solution either produces no change of color, 
or it merely intensifies it; it never changes it to green or 
crimson, as it does with cochineal and red fruit colors. 
Tannin gives a red precipitate with the original solution. 
A solution of chlorin causes no change. 

The above tests will suffice to distinguish blood from 
many red solutions, such as cochineal, kino, madder, log- 
wood, and the various red fruit-juices, none of which coagu- 
late by heat, and all of which are changed in color by the 
addition of ammonium hydroxid. The stain produced by 
lemon or orange juice on the blade of a knife, after exposure 
to the air, may bear some resemblance to an old blood stain ; 
but the tannin test of the solution would immediately detect 
the diflference. So, the stain from red paint (which con- 
tains iron) or from iron-mold is easily identified by its solu- 
bility in dilute hydrochloric acid, and subsequent indication 
of iron. 

The Giiaiacum Test constitutes a striking and satisfac- 
tory chemical test for blood. It depends upon the follow- 
ing conditions : A freshly-prepared tincture of guaiacum, if 
dropped into water, precipitates the resin, which, if exposed 
to the air, gradually acquires a bluish color. If it be exposed 
to a jar of oxygen gas, the bluing process is more rapid ; 
and if brought in contact with ozone, the blue color is 
instantly produced. Hence, the bluing must be owing to 
oxidation. Moreover, while the resin is blued by a variety 
of mineral and organic substances, the coloring matter of 
the blood has no effect upon it. The guaiacum test de- 



Il8 MEDICAL JURISPRUDENCE. 

pends, then, upon the fact that while the blood has no 
power to oxidize or blue the resin, the presence of hydrogen 
dioxid, which itself has no power to oxidize the guaiacum, 
causes the resin then to be oxidized by the blood, and the 
blue color appears. According to Taylor, an excellent way 
of showing the experiment is to add a few drops of the tinc- 
ture (freshly prepared from portions of the resin taken from 
the center of a lump) to a small quantity of water; this 
will precipitate the resin. Di-vide the water suspending the 
resin into two portions ; into one of them pour a little solu- 
tion of red coloring matter of blood; to the other add a 
few drops of hydrogen dioxid solution (see below) ; no 
change of color is observed in either portion. Now, to the 
first portion add a few drops of the hydrogen dioxid solution, 
and to the second a few drops of the red solution ; in both 
cases the sapphire-blue color will soon be seen. In case 
the solution is turbid from an excess of the resin, the addi- 
tion of a few drops of alcohol will instantly clear it and 
bring out the fine blue color distinctly. If the simple addi- 
tion of the blood solution to the guaiacum produces a blue 
color, w^e may be certain that some oxidizing substance is 
present besides blood, and which conceals its presence. The 
force of the experiment consists in the fact that blood, of 
itself, will not blue guaiacum ; but in the presence of hydro- 
gen dioxid the blue color is speedily produced. 

Care should be taken to use a good quality of hydrogen 
dioxid solution. There is much sold which is practically 
worthless. 

Objections have been raised against this test on the 
ground that other substances besides blood will produce 
a blue color in the presence of guaiacum and hydrogen 
dioxid, such as saliva, bile, and red wine; but as regards 



THE GUAIACUM TEST. II9 

the two former, their color should at once distinguish them 
from blood, while the latter substance requires exposure for 
some hours to produce the same result ; whereas, in the 
case of blood the effect is immediate. This test is as avail- 
able for old as for fresh blood, for concentrated or diluted 
blood ; hence, for a washed-out blood stain — wherever, in 
fact, a particle of red coloring matter remains. If no bluing 
occurs in the presence of the guaiacum and the dioxid, it 
will be safe to affirm that there is no blood present. With 
an old blood stain, or one that is too small to afford a suffi- 
cient solution, or where there may be some doubt of its 
presence on a colored material, a very good plan is to 
moisten the spot first with a few drops of water, then with a 
sufficient quantity of the guaiacum tincture, and afterward 
with a few drops of the dioxid, and then press upon it a 
piece of white tissue or filtering paper ; immediately there 
will appear upon the paper the characteristic blue stain. A 
number of such impressions may thus be taken from one 
spot, by simply adding a little more of the guaiacum and 
the ether, and repeating the pressure upon the paper. 

It is known that many substances other than blood will 
cause the reaction. Among these are compounds contain- 
ing iron (ferric), copper, manganese, and gold, also glue, 
casein, and potato skin. It is obvious that many of these 
substances will not be encountered in actual medico-legal 
work and with others the interference can be easily avoided. 
It is also stated that cloth dyed with indigo will simulate 
blood. The test is not to be relied on by itself. It is an 
excellent preliminary test. A negative result shows that 
blood pigment in a soluble form is not present ; a positive 
result will not prove the presence of blood. 



120 MEDICAL JURISPRUDENCE. 

Hemin Crystals. — The production of these (known as 
Teichmann's test) is proof of the presence of blood, but 
does not distinguish human from other blood. A small 
portion of the material to be tested is placed on a micro- 
scope slide, a drop of water added, and a minute fragment 
of sodium chlurid. The slide is then heated to dryness 
on the steam bath, residue covered with a cover-glass, 
and a drop of glacial acetic allowed to run under this. The 
slide is again heated until bubbles arise under the cover- 
glass. It is then allowed to cool, when the hemin crystals 
will form. (E. S. Wood, Witthaus and Becker, Med. Jur. 
and Tox.) 

Serum Test. — The following account of this test is taken 
from an article by Prof. E. S. Wood, of Harvard College, 
in Boston. Med. and Surg. Jonr., April 24, 1902. If a rabbit 
is treated with about half a dozen injections of ten c.c. each 
of human blood or blood serum, the injections being into 
the peritoneal cavity and performed at intervals of several 
days, the blood of the animal develops a substance which 
has been termed " precipitin," that causes a precipitate in 
human blood or blood serum, but not in that of any other 
animal except possibly some of the apes. For a description 
of the method of preparing the animal reference may be 
made to a paper by Dr. W. F. Whitney in the journal 
quoted above. After the rabbit is " humanized," it is 
allowed to rest for about a week and then some blood 
drawn from it. A little from one of the large veins of the 
ear will serve. This is placed in a cool place and allowed 
to coagulate, the serum being used. 

If fresh blood is to be tested, it is to be diluted to about 
i-ioo with normal salt solution. The liquid thus obtained 
should have a light pink tint and if not clear should be 



HEMIN CRYSTALS. 121 

allowed to settle completely and the supernatant fluid de- 
canted. Dry blood stains should be scraped off on to a 
watch glass if upon non-porous materials ; if on a porous 
material, a small piece of this should be cut out. The ma- 
terial is treated with a few drops of distilled water until all 
soluble matter has been taken up. The clear solution is 
transferred to a very narrow test-tube and mixed with an 
equal volume of double normal salt solution. The liquid 
is then tested by adding to it a few drops of the humanized 
serum. If the solution contains human blood serum there 
will be obtained promptly a precipitate, at first very slight 
but in about thirty minutes it will be distinct. The reaction 
occurs best at blood heat. The manipulation is best per- 
formed by allowing the rabbit serum to flow down the side 
of the tube and underlay the liquid to be tested. The pre- 
cipitate can then be seen at the point of contact. 

It should be observed that the chemical tests will not dis- 
tinguish arterial from venous blood. 

II. The Microscopic Test. — This consists in the identi- 
fication of the blood corpuscles — especially the red ones — 
by means of the microscope. 

The class of stains adapted for microscopic examination 
are those in which decomposition has not taken place. If 
the stain upon the garment has been moist, or submerged 
in water for a considerable time, decomposition may have 
led to the dissolution of the corpuscles, and hence interfere 
with the microscopic examination of the blood. Such 
materials containing blood will offer the best results to the 
chemical and spectroscopic methods. Of the other class 
of stains submitted for examination, they will be either ( i ) 
fresh, that is stains which have not died, and in which the 

12 



122 



MEDICAL JURISPRUDENCE. 



blood may or may not be coagulated, and (2) dry stains, 
which will be hereafter referred to as " old stains." 

In the examination of the fresh stains, it will only be 
necessary to make a thin spread upon a glass slide and 
allow it to dry. This is usually best accomplished by 
placing the moist blood upon the slide and sweeping the 
edge of another slide over it, thus scattering the blood in a 
thin layer, which must be allowed to dry and can be 
examined at leisure and preserved indefinitely. 

For the examination of dried stains, the following re- 
agents and apparatus will be needed: — Chemically clean 
slides and cover-glasses, an alcohol lamp, a sharp knife of 
solid metal (so-called antiseptic handle), a microscopic 
needle, and a small oiler with clean oil. A moist chamber, 
such as is used in bacteriologic work, may be of use. The 
reagents will be — 



(ist) Water 

(2d) Potassium hydroxid . . i part. 
Water 2 parts. 

(3d) Muller's fluid : — 

Potassium dichromate . I part. 
Sodium sulphate ... 2 parts. 
Water ; Icx) parts. 



(4th) Muller's fluid 
Glycerol, q. s. 

The glycerol is added until a sp. 
gr. of 1028 is obtained. 

(5th) Glycerol i part. 

Water 6 parts. 

(6th) Sodium sulphate . . . 6 parts. 
Water 8 parts. 



The blood stains to be examined will be upon bibu- 
lous materials or non-bibulous materials. The first includes 
clothing, wood (unvarnished or unpainted), carpets, and 
similar materials. The second includes metallic weapons, 
buttons, glass, chinaware, highly polished and painted 
woodwork, etc. 



THE MICROSCOPIC TEST. I 23 

In searching for the stains upon bibulous materials, an 
ordinary hand glass or a two-inch objective may be used 
to advantage. The light demanded will depend upon the 
color and character of the goods, so that it may be neces- 
sary to try bright and diffused daylight and artificial light. 
The blod spots, when found, may consist of distinct drops, 
smears, or smudges, and stains which have been influenced 
by the dilution of the blood, such as by washing the stain 
or stains which have fallen upon a wet garment, or a gar- 
ment which has been made wet before coagulation or dry- 
ing of the blood took place. It is to be remembered that 
the more rapidly the blood dries, the better it will be pre- 
served, and for this reason the best cells will be obtained 
from the smaller clots or diffused smudges, or stains which 
have dried rapidly. 

To prepare a slide for examination, the suspected spot in 
clothing, for example, is bent and laid upon a glass slide, 
which has previously been breathed upon, in order to make 
it sufficiently moist to cause the adhesion of the small par- 
ticles which may fall upon it. The knife blade is then 
passed through the flame of an alcohol lamp, in order to 
destroy any organic material which may adhere to it ; then 
the surface of the cloth is gently scraped with the knife 
blade, until a thin layer of the broken-up stain is distinctly 
visible to the naked eye upon the slide. A cover-glass is 
then dropped on this, and one of the above solutions 
allowed to flow under from the margin until it has dispersed 
the air from beneath the cover-glass, at least most if not all 
the air. 

The slide may be examined immediately ; but, if it is 
necessary to allow it to soak for any length of time, the 
evaporation of the fluid may be prevented by running 



124 MEDICAL JURISPRUDENCE. 

around the margin of the glass a small quantity of oil — 
ordinary machine oil being applicable for this purpose. 
The fluid containing glycerol and the potassium hydroxid 
solution do not, as a rule, require this precaution except in 
very warm and dry weather, or when the slide is placed in 
a moist chamber and allowed to digest. It is better to pre- 
pare a series of slides from each stain, using different fluids, 
because sorne stains will react differently with different 
fluids. 

The stains on non-bibulous surfaces may be chipped off 
by means of a knife or small needle, placed upon a slide 
and broken up, a cover-glass dropped on, and then treated 
as already described for stains on bibulous materials. Be- 
fore preparing any slide, and between the examination of 
any two spots, the knife or needle should be heated in order 
to destroy any corpuscles which may have adhered from a 
previous examination. The time necessary for the corpus- 
cles to resolve will vary from a few minutes to twelve hours, 
in most cases, and rarely be twenty-four or forty-eight 
hours. During the interval, however, frequent examina- 
tions should be made, lest the corpuscles swell up and 
oval ones become round, and round ones entirely disappear. 

In all cases it is proper to make a measurement of the 
corpuscles, and in order to do this, two micrometers will be 
needed — one known as the stage micrometer, ruled in 
TuW of an inch, and the other an eye-piece micrometer, ruled 
with equidistant parallel lines, usually t^o of an inch apart, 
although this is not a matter of any great importance, as 
the eye-piece micrometer must be standardized before each 
observation. To accomplish this the eye-piece micrometer 
should be placed in the eye-piece, and the stage microm- 
eter upon the stage of the microscope, and the lens and 



THE MICROSCOPIC TEST. 125 

length of tube so adjusted as to give thirty-two hues of 
the eye-piece micrometer betweeen the lines of tw of an 
inch ruling on the stage micrometer, or ten of the ttjW 
of an inch, which is, of course, equivalent. Artificial light 
is best, as it can be regulated. Very accurate measure- 
ments can be made by this method. 

The blood corpuscles of man and most of the mammals 
are circular, biconcave disks without nuclei. The excep- 
tion to this is in the corpuscles of the camel and llama, 
which are oval but without nucleus. The blood corpuscles 
of reptiles, birds, and fishes are oval and have a nucleus, 
with the exception of the lamprey, in which the corpuscles 
are circular, but nucleated. By reference to the accom- 
panying table, there will be little difficulty in differentiating 
corpuscles belonging to mammals from those of reptiles, 
birds, and fishes. 

That human corpuscles are altered by some diseases, does 
not militate against the microscopic examination. There 
is no disease in which the mammalian characteristics are 
entirely lost, and in which an expert microscopist would be 
likely to be misled. In pernicious anemia, leukemia, pur- 
pura, yellow fever, and allied diseases, the blood undergoes 
important changes, but this does not disguise the character- 
istic appearance of blood corpuscles. It is not deemed 
necessary to go into any discussion over the question 
whether the expert can differentiate the blood of a human 
being from that of other mammals ; sufficient to say that all 
the expert can consistently do, in the present state of our 
knowledge, is to say that the blood is mammalian blood, 
and from his examination and measurements it is consistent 
with human blood. 



126 MEDICAL JURISPRUDENCE. 

Sources of Error. — In making the examination it is to 
be remembered that solutions of the same specific gravity 
of the blood, or lighter, will lead to the eventual swelling 
up and dissolution of the corpuscles, and that from long 
soaking oval corpuscles may become circular from the 
imbibition of water. Certain vegetable structures, notably 
sporules and some algae, may resemble blood cells ; but the 
vegetable cell is not biconcave and has not the translucency 
of the animal cell, and prolonged soaking does not alter it 
as it does the blood corpuscle. 

The following tables present a synopsis of trustworthy 
measurements of the blood corpuscles of various animals : 



COMPARATIVE SIZE OF BLOOD CORPUSCLES. 



27 



COMPARATIVE SIZE OF BLOOD CORPUSCLES. 

(The figure is the denominator; the numerator is always unity.) 



Animal. 



Man 

Guinea Pig 

Wolf 

Dog 

Rabbit 

Ox 

Pig 

Horse 

Sheep 

Goat 

Monkey 

Kangaroo 

Beaver 

Seal 

Walrus 

Elephant 

Great Ant- Eater .... 

Capybara 

Sloth 

Whale 

Opossum 

Cat 

Musk Rat 

f Long diameter 
^^"^1 -jshort - 

( Long diameter 
^^^^^"" jshort " 

f Long diameter 
^"'■^^y-i Short - 



Observer. 



3200 

3538 
3600 
3532 
3607 
4267 
4230 
4600 

5300 
6366 
3412 
3440 
3325 
3281 
2769 

2745 
2769 
3190 
2865 
3099 

3557 
4404 

3550 
3361 
6229 
2102 
3466 
2045 
3598 



3250 

3223 
3422 
3561 

3653 
4219 
4268 

4243 
4912 
6189 
3382 
3410 



2738 
3164 



3145 
4372 
3282 
3201 
6408 
2080 

3483 
1894 

3444 



3200 

3400 
3450 
3580 
3662 
4200 
4250 
4310 
5000 
6100 
3400 
3400 

3325 
3200 



S 2 = 
< 0.1U 



3200 

3500 
3600 
3500 
3600 
4200 
4200 
4500 
5000 
6100 
3400 
3400 
3300 
3200 
2700 
2700 
2700 
3100 
2800 
3CX)o 
3500 
4400 
3500 
3300 
6300 
2100 
3500 
2000 
3500 



Appearance of Cell. 



Biconcave disk without 
nucleus. 



|Oval, biconcave with- 
j out nucleus. 

[-Oval, with nucleus. 



128 



MEDICAL JURISPRUDENCE. 



Comparative Size of Blood Corpuscles. — {Continued.) 

(The figure is the denominator; the numerator is always unity.) 



Animal. 



Pigeon 
Quail . 
Dove . 
Goose . 

Duck . 

Tortoise 
(Land) 

Turtle 
(Green) 

Viper . 

Frog . 

Toad . 

Trout . 

Perch . 

Eel . . 
Lamprey 



r Long diameter 

I Short " 

f Long diameter 

I Short " 

f Long diameter 

I Short 

f Long diameter 

I Short 

f Long diameter 

I Short " 

f Long diameter 

1 Short *♦ 

( Long diameter 

I Short *' 

f Long diameter 

t Short 

f Long diameter 

I Short 

f Long diameter 

1 Short " 

f Long diameter 

1 Short 

I Long diameter 

1 Short 

I Long diameter 

I Short 

nucleus of 



Observer. 



1973 
3643 
2347 
3470 
2005 

3369 
1836 

3839 
1937 
3424 
1252 
2216 
1231 
1882 
1274 
1800 
1108 
1821 

1043 
2000 

1524 
2460 
2099 
2460 

1745 
2842 

2134 
6400 



1892 
3804 



1955 
3504 
1250 
2200 



1089 
1 801 






1900 
3700 
2300 
3500 
2000 
3300 
1800 
3800 
1900 
3500 
1200 
2200 
1200 
1900 
1200 
1800 

IIOO 

1800 

1000 
2000 
1500 
2400 
2100 

2500 

1700 
2800 
2100 
6400 



Appearance of Cell. 



Oval, with nucleus. 



Disk with nucleus. 



THE SPECTROSCOPIC TEST. I 29 

III. The Optical or Spectroscopic Test. — The apphca- 
tion of the spectroscope to the identification of blood de- 
pends upon the fact that various colored solutions possess 
the power of absorbing different portions of the spectrum, 
producing in the latter certain dark spaces, called absorption- 
bands. Blood produces a very decided effect, even in 
minute quantities. 

When fresh hemoglobin is examined by the spectroscope, 
it will be seen to produce two absorption-bands of different 
widths in the green. When hemoglobin is acted upon by 
acids and alkalies, or kept for a long time, especially in a 
damp place, it acquires a brown color, becomes deoxidized, 
and is finally changed into hematin. The spectrum of 
deoxidized hemoglobin, or of venous blood, shows a single 
broad absorption-band, visible in the green. After a short 
exposure to the air it gives a spectrum with the two bands 
of oxidized hemoglobin much weakened, with a third band 
visible in the red (methemoglobin). The spectrum of de- 
oxidized hematin, or of blood after prolonged exposure to 
air, shows two well-defined bands in the green, but stronger 
than with fresh hemoglobin and with disappearance of the 
band in the red. 

Sturve's process for the extraction of blood stains is 
recommended by Klein. It consists in placing the stained 
spot in a test-tube and covering it with a small quantity of 
cold water, through which a slow stream of carbon dioxid 
is made to pass. If the stain is fresh (within a day), the 
solution will be complete in about ten minutes ; if a month 
old, about thirty minutes will be required ; if two months 
old, one hour's exposure may be necessary. The clear 
solution thus obtained is to be examined spectroscopically. 
In the case of very fresh stains, the two absorption-bands 



130 MEDICAL JURISPRUDENCE. 

of oxyhemoglobin are alone visible ; but in proportion to 
the age of the stain, the methemoglobin-band in the red 
portion becomes more and more decided, and in stains six 
to eight months old this is the only band visible. 

A dilute solution of hydrogen cyanid (i to 2 drops of a 
1 : 1000 solution) has the effect of changing the methemo- 
globin-band in the red into the two characteristic bands 
of hemoglobin in the yellow and green portions ; whilst 
solutions of fresh blood stains are apparently unchanged. 
Hence the action of this reagent may possibly afford a 
means of determining the age of a given stain. 

The form of apparatus best adapted for spectroscopic 
examination of blood is that suggested by Sorby, to whose 
researches we are largely indebted for our knowledge 
in this branch of investigation. It is a combination of the 
microscope and spectroscope. The micro-spectroscope has 
the advantage over the ordinary spectroscope in that a 
comparison prism is inserted, by means of which a fluid of 
known composition may be compared with the fluid under 
investigation, the two spectra appearing under the micro- 
scope side by side. The fluid prepared for micro-spectro- 
scopic examination is the same as that used for the 
ordinary spectroscope, which has been previously described. 
By using cells made from the segments of barometer tub- 
ing, a very thick layer of blood, one inch in depth, may be 
used in the spectroscope, when only four or five drops of 
the suspected fluid are obtainable. 

The important question in this connection is — Do other 
substances give similar spectra to those of blood? Accord- 
ing to Sorby, nothing gives a spectrum precisely similar 
to that produced by oxyhemoglobin, although certain other 
bodies produce absorption-lines somewhat resembling the 



THE SPECTROSCOPIC TEST. I3I 

former, but easily distinguishable by a practiced observer. 
Thus, the coloring matter of the petals of Cineraria give 
two absorption-bands ; but they are easily distinguished by 
the action of ammonium hydroxid. Cochineal, madder, and 
other red dyes, dissolved in alum, although affording bands 
somewhat resembling those produced by blood, may be dis- 
tinguished from the latter by the use of ammonium hydroxid 
and potassium sulphite. 

We must, therefore, admit that the spectroscope affords 
a valuable and delicate test for the presence of blood. It 
cannot, however, discriminate between human blood and 
that of any of the lower animals ; in this respect, therefore, 
it is inferior to the microscope, as a test. 

BURNS AND SCALDS. 

A bum is an injury to the body, caused by heat applied 
either in the form of a heated solid substance, or by flame, 
or by radiant heat. 

A scald is an injury produced by a heated liquid applied 
to the body. 

Burns and scalds are not, strictly speaking, wounds ; 
though legally they are comprised under the term, bodily 
injuries. The effects of corrosive liquids, such as sulphuric 
and other mineral acids, and the strong alkalies, closely 
resemble burns, and they are so regarded in law. Boiling 
liquids taken internally may produce internal scalds. 

The intensity of a burn is dependent upon the degree of 
heat applied : it varies from a slight redness to a complete 
charring of the tissues. Metals heated to redness produce 
very severe burns, even to the destruction of the flesh ; but 
if in a state of fusion, the injury is yet more serious, in con- 
sequence of the partial adhesion of the molten mass to the 



132 MEDICAL JURISPRUDENCE. 

skin. Boiling oils produce as decided effects as hot solids 
or molten metals. Boiling water causes scalds, more or less 
severe, attended with vesications containing serum ; but it 
never chars or destroys the tissue. 

According to Dupuytren, burns may be classified as fol- 
lows, according to their degree or extent: 

1. Superficial inflammation of the skin, without vesi- 
cation. 

2. Vesication, or blisters, containing serum, sometimes 
clear, and sometimes opaque and bloody. If the cuticle be 
removed, the true skin is very red and granulated, and 
secretes pus. 

3. Destruction of the external surface of the true skin, 
forming an eschar, which may be soft and yellow if made 
by a liquid, or hard and brown or black, if resulting from 
a solid. The surrounding skin is red and blistered. This 
form of burns leaves ugly cicatrices, which are white and 
shining. 

4. Disorganization of the whole skin ; these differ from 
the last only in the deeper destruction of the parts, and in 
the thickness of the sloughs. The resulting scars are 
puckered, and depressed below the level of the skin. 

5. The destruction here extends through the skin, and 
includes the cellular tissue and a portion of the muscles. 
The general character is the same as in 4. 

6. Complete carbonization of the burnt part, as when a 
portion of the body is roasted by the fire. 

The important medico-legal question to determine is — 
Was the burn upon the body made before or after death? 
It is evident that an assassin might murder his victim, and 
then set fire to the house, hoping thus to escape detection. 
If a body be found completely charred, it will be impossible 



DID THE BURN OCCUR BEFORE OR AFTER DEATH? 1 33 

to determine whether it was Hving or dead when acted upon 
by the heat; but if the burn be less extensive, it may be 
possible ^to form an opinion. 

As regards vesications which result from moderately 
heated solids, or from scalding liquids, if they contain serum 
their presence, as a rule, indicates that the burn was in- 
flicted during life. The experiments of Christison, Taylor, 
and Tidy go to show that, although the application of heat 
to a body within a few minutes after death may sometimes 
produce a blister, this, however, does not contain serum, 
but only gas ; serous exudation must be regarded as vital. 
There may be an exception to the above rule in the case of 
dropsical subjects, in whom it is stated on good authority 
that serous blisters may be produced after death, by the 
application of heat. But, on the other hand, the absence of 
vesication should not be regarded as a proof that the burn 
was not inflicted during life, since vesication is not always a 
necessary result of a burn ; besides, it is quite possible that 
only the more serious results may be visible. It is recom- 
mended, in all doubtful cases, to examine the cuticle mi- 
nutely, with a lens, for minute apertures through which the 
serum may have escaped. 

Another sign of burning during Hfe is the presence of a 
red line around the burn, which gradually merges into the 
color of the surrounding skin. This red border remains 
after death, and cannot be produced, acording to Christison 
and Taylor, by the application of heat to the dead body. 
Tidy's conclusions, based upon a series of his own experi- 
ments, are that " when serous blisters are seen on a dead 
body, the serum being thick and rich in albumin, and the 
blisters surrounded by a deeply injected red line, the true 
skin, after the removal of the cuticle, also presenting a 



134 MEDICAL JURISPRUDENCE. 

reddened appearance, the evidence is strong that the burn 
was produced during the life of the person ; while it is con- 
clusive that it was caused during the life of the part. But 
if the blister contains air, the true skin, after the removal of 
the cuticle, appearing dry and unglazed, of a full white 
color, or grayish ; or, if the blister contained a little thin, 
non-albuminous serum, there being in neither case any red 
surrounding line, nor any injected condition of the cutis 
vera, the evidence is strong that the burn was inflicted after 
death." 

The danger of burns depends more on their extent than 
their depth. The reason of this is that extensive burns 
involve a greater number of sensory nerves, and a greater 
extent of surface is prevented from performing the function 
of excretion and heat regulation. Thus, a large superficial 
scald, especially in young children, is very apt to prove 
fatal, the symptoms being stupor, somnolence, pallor of 
face, and feeble pulse, with slow and stertorous breathing — 
very similar to those of narcotic poisoning, for which, in- 
deed, they have sometimes been mistaken. It has been 
ascertained that if one half to two thirds of the entire skin 
be involved, the burn will certainly prove fatal ; but practi- 
cally, one involving one third of the body, if severe, would 
be very likely to cause death. But here, many circum- 
stances will have to be considered, such as the age, consti- 
tution, the part affected, and the character of the burn. 
Burns are more dangerous in the young; more so on the 
trunk of the body than on the limbs ; and more so if in 
separate patches than if continuous, provided they are of 
equal extent. Gunpowder burns are considered more dan- 
gerous than those produced by steam. 

The Causes of Death from burns are various : as ( i ) 



DID THE BURN OCCUR BEFORE OR AFTER DEATH? 1 35 

bodily injury; as in the case of conflagrations of buildings, 
where instantaneous death may result from the fall of tim- 
bers, walls, etc., or from leaping out of a window, or from 
a roof. (2) SuflPocation, either from the smoke, or from the 
want of air. (3) Shock; this is probably the most frequent 
cause of death after extensive burns. (4) Coma, convul- 
sions, or tetanus. (5) Bronchitis, pneumonia, and other 
thoracic symptoms. (6) Enteritis and peritonitis. (7) 
Exhaustion. (8) Gangrene, pyemia, etc. 

Post-mortem Appearances. — These are often not well 
marked, the most constant lesions being a capillary injec- 
tion of the mucous membrane of the alimentary canal and 
bronchi, and serous effusion into the ventricles of the brain. 
In cases where the death has occurred from injury, or from 
suffocation, the usual lesions would, of course, be discov- 
ered after death; but if the body has been completely 
charred or roasted, it will probably be impossible to distin- 
guish anything to enable us to form an opinion as to whether 
the death had preceded the burning or not. The means of 
identifying the charred remains of a burnt body have already 
been pointed out. 

Wounds upon the Burned. — From the fact that murder 
is frequently committed and the body subsequently burned 
by a criminal, with a view of destroying the traces of his 
crime, it is important for the legal physician always to ex- 
amine the body for wounds. There are certain mechanical 
effects produced upon the body by fire which might possi- 
bly be mistaken for wounds made before death, such as 
fissure in the thorax or abdomen, or in the neighborhood 
of the large joints. These fissures are generally irregular 
in form ; and as the blood-vessels, by their elasticity, are apt 



136 MEDICAL JURISPRUDENCE. 

to escape being torn, these may be seen intact, stretching 
across the fissure. This appearance is always indicative 
that the opening was caused by heat, and was not a real 
wound. A case is mentioned in which two old persons were 
found burned in their house ; the fact of their having been 
previously stunned, if not killed, by blows on the head, was 
ascertained by the existence of fractures of the skull, under 
which coagulated blood was found upon the dura mater. 
Where the heat has been excessive, the bones of the de- 
ceased may be found more or less cracked or split, and 
sometimes even crumbled to pieces. Ordinary incised, 
punctured, or contused wounds, made before death, could 
not be identified in a body completely charred by fire. 

As to the question of the burning being accidental, sui- 
cidal, or homicidal, it may be assumed that death by burn- 
ing is nearly always accidental; and such cases are, unfor- 
tunately, of frequent occurrence. Death, in such accidental 
instances, mostly occurs at some distance from the fire, in 
consequence of the removal of the injured person; although 
of course it may take place at the time and place of the 
conflagration. The fact that a dead body is found near the 
fire may very naturally suggest the idea of accident, since 
an intoxicated or a diseased person may have caught fire 
and been unable to move. In all such cases, it is important 
to examine the body for marks of violence, with the pre- 
cautions given above. Furthermore, a case might present 
itself where severe wounds were found on a burnt body, 
and the question might arise whether the wounds or the 
fire had been the cause of death. No general rules can be 
given for guidance in such cases ; each one must be deter- 
mined by the attending circumstances. 

The question of Spontaneous Combustion of the human 



WOUNDS UPON THE BURNED. 1 37 

body presents itself here for a brief notice. It has occa- 
sioned considerable discussion in the scientific world for 
many years past ; but although some remarkable instances 
are related of apparent spontaneous combustion of the 
human body, originating while alive, on close investigation 
it will be found that some source of fire had invariably been 
present, from which the combustion took its origin, such as 
a lighted pipe or candle, and that the body was that of a 
habitual spirit-drinker, and nearly always that of a very fat 
person, conditions highly favorable for the process of com- 
bustion when once originated. 

From the known composition of the human body — nearly 
75 per cent, being water — it would seem to be impossible 
even to burn it up, except by the application of a high 
degree of heat, and for a long time, such as is required by 
the process of cremation. Certainly, the weight of authority 
is against the belief in spontaneous combustion of the 
human body ; no person of position or authority has ever 
witnessed such a phenomenon. 

It is, of course, an admitted fact that various organic and 
mineral substances undergo rapid combustion, through the 
action of oxygen, especially when exposed to the action of 
the air, in a state of fine powder or extended surface, as in 
flour-mills and other places where much fine dust is evolved. 
Conflagrations of large buildings have frequently thus orig- 
inated, involving important questions as to incendiarism and 
fire insurance. 

DEATH FROM DIFFERENT FORMS OF APNEA 
(ASPHYXIA). 

This includes death from Suflfocation, Strangulation, 
Hanging, and Drowning, in all of which life is destroyed 
13 



138 MEDICAL JURISPRUDENCE. 

chiefly, if not exclusively, by apnea or asphyxia. All 
these modes of violent death possess certain points in com- 
mon, while, at the same time, each of them is distinguished 
by individual peculiarities, which render a separate consid- 
eration desirable. Their common properties will be first 
briefly considered. 

In all cases of apnea, death begins in the lungs, and this 
is brought about simply by excluding the air from these 
organs. This is brought about in various ways: mechanical 
pressure upon the throat or thorax, as in throttling; by 
ligature around the throat, as in hanging and strangling; 
by the flow of water into the windpipe, as in drowning; by 
foreign bodies getting into the larynx and trachea, as in 
choking; by being shut up in a box, entombed alive, or 
buried under ruins, or in a sand bank, or snow drift ; or by 
some disease of the throat, as edema and spasm of the 
glottis, membranous croup, etc. ; — all of which produce 
death by simply arresting the function of respiration. 

Likewise, there are exhibited certain signs or phenomena, 
both before and after death, which indicate death by apnea. 
These are lividity of the lips, fingers, and other extremities, 
and generally of the whole face, together with a swollen 
appearance of the countenance; convulsive movements of 
the arms and legs, at first partly voluntary, but soon be- 
coming spasmodic and involuntary, as seen in the struggles 
to breathe ; the veins become turgid ; the pulse, at first full 
and rapid, soon becomes feeble; there is often frothing at 
the mouth, which may, at times, be tinged with blood from 
wounding of the tongue ; there is frequently turgescence of 
the genital organs, and involuntary discharges of semen, 
urine, and feces. Abortive attempts at respiration are made 
for a while, but finally these cease, and the heart at last 
ceases to pulsate. 



VIOLENT DEATH FROM APNEA. I 39 

Consciousness is lost very early, although in the earliest 
stage there may be remarkable activity of the senses. This 
stage lasts only for a very brief time ; such is the testimony 
of persons who have been rescued from drowning, or who 
have been cut down from hanging, and of those who have 
experimented upon themselves by partial strangulation. 

This kind of death is rapid, not requiring more than 
three to five minutes, though there are some apparent 
exceptions in the case of drowning. These will be referred 
to hereafter. 

The post-mortem appearances in all these varieties of 
death by apnea are, in the main, very similar. These are 
lividity of the lips, fingers, and other parts of the body, as 
seen before death ; in drowning, the face is apt to be pale ; 
sometimes, likewise, in hanging. The venous system is 
generally full of blood. The right side of the heart, 
together with the lungs, is usually gorged with dark blood ; 
if death has been rapid, post-mortem clots will be found in 
the heart cavities ; if it has been slow, ante-mortem or white 
clots may be found ; the mucous membrane of the bronchial 
tubes deeply congested. In young persons, the blood- 
vessels of the lungs will often be found empty, and the 
lungs emphysematous, from the violent efforts made to 
respire. Minute extravasations of blood (ecchymoses) are 
found in the mucous and serous membranes, as the pleura, 
pericardium, endocardium, peritoneum, etc. The veins and 
sinuses of the brain are usually turgid with blood, and the 
brain itself filled with bloody points. The solid viscera, as 
the liver, spleen, and kidneys, will generally be congested. 
The blood itself is mostly fluid and dark-colored, except 
in suffocation from carbon monoxid, when its color is 
bright red. 



140 MEDICAL JURISPRUDENCE. 

Suffocation, properly speaking, includes every variety 
of death resulting from an impediment to respiration. But 
as Strangulation, Hanging, and Drowning are considered 
separately, the term is here restricted to the other modes 
or death by apnea. 

Cases of accidental suffocation are numerous. Infants 
have thus perished by being too closely wrapped up, or by 
being overlaid by their mothers. Young children, feeble 
persons, epileptics, and drunkards, have been suffocated by 
falling into ashes, soft mud, feathers, and similar articles, 
from which they have been unable to extricate themselves. 
Mechanical pressure on the thorax, as occurs in vast 
crowds of people, has destroyed life by suffocation. The 
accidental slipping into the larynx of small bodies, such as 
peas, grains of corn, marbles, etc., from the mouth, particu- 
larly in children; the lodgment of a piece of meat in the 
air passages (choking) ; the detachment of a bronchial 
gland which becomes impacted in the larynx; the escape 
of a lumbricus from the stomach, and its entering the 
larynx; the passing of vomited matters and of blood into 
the windpipe ; various disorders of the throat, as edema and 
spasm of the glottis, croup, diphtheria, abscess, etc. ; — all of 
these are examples of accidental suffocation. 

Suicidal suffocation is extremely rare, though a few 
remarkable cases are mentioned by authors. In one case — 
that of a young woman — death was caused by a ball of 
hay, which she had thrust down the throat in the pharynx, 
behind the larynx, and which was just visible when the 
mouth was widely opened. 

Homicidal suffocation is usually practised upon infants, 
the aged, or those who are otherwise helpless. Suffocation 
is undoubtedly a very common mode of destroying new- 



SUFFOCATION. I4I 

born children ; it is very easily effected, and may leave be- 
hind it no characteristic traces; death, in such cases, being 
usually attributed to convulsions. The notorious Edin- 
burgh murderers, Burke and Hare, destroyed their victims 
by suffocation, forcibly closing the mouth and nostrils of 
the person, and at the same time bearing their whole 
weight upon the breast. A curious Scotch case is recorded, 
in which an intemperate woman, over sixty years of age, was 
found dead, with a wound upon the scalp, emphysema in 
the chest, and seven ribs fractured. The face was pale and 
composed, the eyes closed, and the tongue slightly protrud- 
ing. On examination, the cork of a quart bottle was found 
in her larynx, the sealed end being uppermost. The epi- 
glottis, trachea, and larynx were considerably injected. It 
was attempted, on the trial, to show that the deceased had 
drawn out the cork with her teeth while she was drunk, 
but that it was suddenly forced into her windpipe ; this was 
negatived by the fact that the sealed end of the cork was 
uppermost, and also by the marks of the cork-screw. It 
was decided that the cork had been forcibly pushed into her 
windpipe, when by reason of intoxication she was unable to 
resist. Another case of homicidal suffocation is that of a 
Russian sentry, found dead in his watch-box, with a large 
piece of meat in the lower part of the pharynx, pressing upon 
and partly in the glottis. His death was, therefore, sup- 
posed to be accidental. Some years after, his superior officer, 
in dying, confessed that he had first suffocated the man, and 
then placed the piece of meat in his throat, in order to divert 
suspicion from himself. 

Post-mortem Appearances. — Lividity and swelling of the 
face and lips are usual, but in accidental cases the face may 
be placid ; the eyes are congested ; minute ecchymoses 



142 MEDICAL JURISPRUDENCE. 

appear on the neck and chest; with mucous froth, some- 
times bloody, about the mouth and nose; the lungs and 
right side of the heart may be gorged with dark blood ; but 
in some cases, especially in young children, the lungs may 
be empty of blood and emphysematous. Hence, the con- 
dition of the lungs and heart, as it varies so much, cannot 
be relied on in a diagnosis. Stress has been laid upon the 
presence of minute punctiform ecchymoses, especially on 
the lungs of new-born infants who have been suffocated. 
These spots are also found on the pleura, lining membrane 
of the heart, membranes of the brain, peritoneum, and 
mucous lining of the windpipe, but their value is not uni- 
versally acknowledged. The blood is dark and very fluid. 
The kidneys are deeply congested. 

As these post-mortem signs are also found in other forms 
of death by apnea, they cannot be considered as character- 
istic of death by suffocation. Consequently, the examiner 
should be cautious in expressing his opinion as to the cause 
of death. If a dead body be discovered in sand, earth, ashes, 
or similar substances, the question whether it was placed 
there before or after death must be decided by a careful 
examination. If the substances be found in the air passages, 
and especially in the esophagus and stomach, it may be con- 
cluded that the person was alive at the time. 

Asphyxia from Gas from Charcoal. — The gases evolved 
by burning charcoal consists of carbon dioxid and carbon 
monoxid; the relative proportion of them will depend on 
the air-supply. If this be abundant, the former gas will be 
considerably in excess ; if imperfect, the latter gas will be 
in greater quantity. Charcoal burning in the open air pro- 
duces but a small amount of monoxid. An atmosphere con- 



ASPHYXIA FROM CHARCOAL VAPOR. I43 

taining' 5 per cent, of carbon dioxid and ^ per cent, of 
monoxid has been said to be fatal to man. There is, how- 
ever, some uncertainty as to the Hmit at which carbon dioxid 
is fatal. 

Symptoms and Post-mortem Appearances. — Headache, 
with a sense of pressure on the temples, vertigo, ringing in 
the ears, and tendency to sleep, complete loss of muscular 
power, troubled vision, difficulty of breathing, rapid and 
feeble pulse, sometimes vomiting, coma, and death, occa- 
sionally preceded by convulsions. Death takes place in 
from one to two hours after exposure ; and experience 
shows that this may occur even when the external air is 
not completely excluded. 

The post-mortem lesions vary, depending upon the rapid- 
ity of the asphyxia, and the time elapsed between the death 
and the autopsy. Sometimes the face is injected, the eyes 
bright and staring, and the limbs supple; again, there is a 
general pallor of the surface and complete rigidity of the 
muscles, coming on very soon after death, and disappearing 
in a few hours. According to Lutaud, the most character- 
istic sign is the presence of large rosy-colored spots, more 
or less pronounced, over the thighs, chest, and abdomen. 
" These rose-colored spots are not seen in any other variety 
of asphyxia and they remain even after the commencement 
of putrefaction." The apoplectic nodules in the lungs, and 
the subpleural ecchymoses, so common in strangulation and 
suffocation, are rarely seen. There is more or less conges- 
tion of the brain. Another important sign is the fluidity and 
bright redness of the blood. This is owing to the stronger 
affinity of the hemoglobin for carbon monoxid than for oxy- 
gen, in consequence of which the former is retained through- 
out the circulation. The spectrum furnished by such blood 



144 MEDICAL JURISPRUDENCE. 

very closely resembles that shown by arterial blood in the 
spectroscope. This affinity of the hemoglobin for carbon 
monoxid will satisfactorily explain the presence of the rose- 
colored spots above alluded to. 

In case of death from gases from charcoal, spectroscopic 
examination of the blood should be made. By this means, 
Brouardel was enabled to demonstrate the existence of 
carbon monoxid in the blood of one of the victims of the 
burning of the Hospital of Saint- Antoine, in 1887. The 
absorption-lines of carboxy-hemoglobin, that is, blood con- 
taining carbon monoxid, are so similar to those of ordinary 
(oxy) hemoglobin that distinction by observation alone is 
difficult. The two spectra may be at once distinguished 
by the fact that the addition of a reducing agent, such as a 
drop or two of ammonium sulphid to the blood, will produce 
at once a reduced hemoglobin in the case of normal blood 
and change the spectrum, while that of carboxy-hemoglobin 
will not be affected. 

Various chemical tests for carboxy-hemoglobin have been 
proposed, but they are of little value. The spectroscopic 
test seems to be the best, but even in undoubted cases of 
poisoning, as where the gas has been directly inhaled with 
suicidal intent, the results of the examination will sometimes 
be unsatisfactory. 

It may be well to remember that the body of a murdered 
person may have been so disposed of by an assassin, as to 
simulate death from charcoal asphyxia; of course all the 
signs of any such antecedent violence should be carefully 
sought. 

When illuminating gas forms about one eleventh of the 
atmosphere, it becomes explosive on contact with a flame. 
It requires, however, a less proportion than this to render 



DEATH BY STRANGULATION. 1 45 

the air incapable of supporting life. The so-called ** sewer- 
gas " explosions are almost always due to the leakage of 
illuminating gas into sewers and drains. 

Many instances of sickness and death may be due to the 
unconscious breathing of deleterious vapors arising from 
leakage of gas-pipes, and escapes of the gas into the apart- 
ments. For further information in reference to gases from 
ordinary combustion see under '' Poisonous Gases." 

The introduction of acetylene as an illuminating and 
heating agent will doubtless give rise to cases of fatal 
poisoning, but there are no data yet at hand to permit a 
satisfactory presentation of the medico-legal relations. 

Asphyxia from Emanations of Cesspools. — These con- 
tain hydrogen sulphid and ammonium sulphid, together with 
other sulphur compounds of unknown composition. 

The symptoms are a sense of fullness and pain in the head 
and stomach, vertigo, nausea, sudden loss of muscular power 
and of consciousness. There is often an escape of bloody 
froth from the mouth. The body is cold, the face livid, 
the pupils dilated and immovable; convulsions and coma 
usually precede death. 

In the examination of cases of asphyxia from the emana- 
tions of cesspools or sewers, the expert should seek to 
isolate the toxic agent (hydrogen sulphid) from the blood. 

Strangulation is produced either by pressure upon the 
neck by means of an encircling cord, or by direct pressure 
made by the hand on the windpipe, as in throttling. The 
means by which the constriction is produced are various: 
sometimes a rope is used, sometimes a strap, a handkerchief, 
a ribbon, or a strip torn from a sheet or the clothing. In 



146 MEDICAL JURISPRUDENCE. 

Spain, the usual mode of execution of criminals is by the 
garrote — a steel collar tightened by a screw, in Turkey it 
is by a bow string. Death results, in most cases, from 
the combined effect of the deprivation of atmospheric air, 
producing apnea, and from congestion of the brain due to 
the pressure upon the jugulars, preventing a return of blood 
from the brain. Sudden and violent compression by the 
hand upon the windpipe will produce unconsciousness 
sooner than if the constriction be made by a band. Stran- 
gulation differs from hanging chiefly in the obliquity of the 
cord around the neck in the latter, while in strangulation 
the cord is wound horizontally around the neck. It is im- 
portant to distinguish between death from strangulation 
and death from hanging, as the former is nearly always the 
result of homicide, while the latter is usually suicide. The 
first question that presents itself is : Was the death caused 
by strangulation? The appearances of one strangled are 
usually very distinctly marked : These are livid and swollen 
face ; staring eyes, with dilated pupils and protruding 
tongue, which may be bitten ; livid extremities ; flattened 
larynx; blood may issue from the nose, mouth, or even 
ears ; the face, neck, chest, and eyes are studded with 
ecchymoses ; the genital organs are frequently turgid ; and 
there may be an escape of urine and feces, as in hanging. 
Internally, the right heart and venous system are some- 
times gorged with blood; but this is less frequent than in 
other forms of death from apnea; this is also true of the 
congestion of the liver and kidneys. Tardieu states that 
the lungs are seldom very full of blood, but he places great 
reliance upon the emphysematous appearance of these 
organs, arising from a rupture of the pulmonary vesicles. 
The subpleural ecchymoses, which he regards as charac- 



DEATH BY STRANGULATION. 1 4/ 

teristic of suffocation, he says, are rare in strangulation. 
There are also extravasations of blood in the lungs, but 
none in the brain, whereby it is distinguished from apo- 
plexy, which it resembles in a few of its symptoms. 

Among the external signs, the marks of the cord, and of 
the fingers on the neck, deserve special attention. These 
are more evident and reliable here than in hanging, because 
in homicidal strangulation very considerable force is gener- 
ally employed by the murderer in order to accomplish his 
object. If the hand has been used, as in throttling, the 
marks of the fingers will be found upon the front of the 
throat — sometimes of two or more fingers and the thumb, 
so that even the particular hand employed may be deter- 
mined. If a cord has been used the mark will be horizontal, 
not oblique, as in hanging; sometimes there may be two 
or three parallel marks, where the cord has been wound 
around the neck several times. The mark of the cord is 
apt to be less deep than in hanging, and subcutaneous ex- 
travasation is not always found; but the parts beneath may 
show considerable infiltration of blood. Fractures of the 
hyoid bone and of the ossified thyroid cartilage are reported 
as having occurred. Where great violence has been used 
to the neck, blood may escape from the mouth and nose. 
The interior of the larynx and trachea is congested, of a 
uniform red or violet color, and is coated over with a 
frothy, bloody mucus, which extends also into the smaller 
air tubes. This internal discoloration of the windpipe 
should not be mistaken for the early signs of putrefaction 
of this organ. 

The mark of the cord around the neck may unquestion- 
ably be produced on the dead body, if the attempt is made 
within a few hours after death, and while the body is still 



148 MEDICAL JURISPRUDENCE. 

warm, but according to Casper, not after six hours. There- 
fore, this particular sign should never be relied on to the 
exclusion of the other characteristic evidences of death by 
strangulation, such as the livid, swollen countenance, the 
protruded tongue, the staring eyeballs, etc., none of which 
are produced by strangulation after death. Hence, although 
a murderer may place a cord around the neck of his dead 
victim, with a view to make the case simulate a suicide, 
there will be little difficulty in detecting the ruse. 

Was the strangling accidental, suicidal or homicidal? 
Cases of accidental strangulation not infrequently occur. 
Taylor records two: one of a girl carrying fish in a basket, 
which was strapped around the upper part of her chest in 
front. She was found dead, sitting on a stone wall. The 
basket had probably slipped off while she was resting, and 
had thus raised the strap, which firmly and fatally com- 
pressed the trachea. The other case was that of a boy, 
whose silk necktie, knotted and tightly twisted around his 
neck, was caught in the band of an engine, and his neck 
drawn down against one of the revolving shafts. He was 
rescued after his neck had been compressed at least one 
minute. He became black in the face, and blood escaped 
from the mouth and ears. For several minutes after the 
removal of the ligature he was insensible, but ultimately 
recovered. Another instance is related by Dr. Gordon 
Smith, of a lad who used to carry a heavy weight sus- 
pended from his neck by a string. One day he was found 
dead, sitting in a chair. He had probably gone to sleep, 
the weight had slipped, and drawn the cord tight around 
his neck. 

Suicidal strangulation is comparatively rare, except among 
the insane, with whom it is by no means uncommon. The 



HOMICIDAL STRANGULATION. 1 49 

facility. of effecting their purpose by such simple means as 
a garter, a ribbon, a handkerchief, or a strip torn from a 
garment, may readily account for such occurrences, and 
still further, when it is remembered how very rapidly and 
insidiously unconsciousness steals over the senses under a 
pressure of the windpipe, thereby taking away from the 
individual the will and the power to escape. A case men- 
tioned by Taylor will illustrate this. An insane man, with 
suicidal tendencies, was placed in a private asylum, with 
special directions to watch him closely to prevent his taking 
his life. Two attendants were placed over him. These 
attendants remained at his bedside; but on his requesting 
them to retire to a little distance, they complied, still keeping 
a close watch upon him. Two hours afterward, the physi- 
cian on visiting the patient, was informed by the attendants 
that he had been sleeping quietly for some time. On ap- 
proaching the bed they found, to their surprise, that the 
man was dead. He had strangled himself simply by tear- 
ing off a strip from the bottom of his shirt, rolled it into a 
cord, and tied it around his neck. Other cases of determined 
suicides are recorded in which the cord was found coiled 
around the neck several times; in one instance, the ligature 
had been tightened by a stick thrust in and twisted like a 
tourniquet ; and in still another, a sabre had been used for 
the same purpose. 

Homicidal strangulation, as already mentioned, is the 
most frequent variety of this form of violent death. It is 
usually recognized by the marks upon the neck and else- 
where, indicating a greater amount of violence employed. 
Thus, the impression of the ligature on the neck will be 
deeper and more ecchymosed than occurs in a suicide ; it 
may also be accompanied by the marks of the fingers on 



150 MEDICAL JURISPRUDENCE. 

the throat, which latter are never found either in a suicidal 
or accidental case. Besides these, there will frequently be 
seen contusions, or injuries of other parts of the body, and 
evidences of a struggle. 

It should not be forgotten that the marks of homicidal 
strangulation may often be discovered many weeks, or even 
years, after burial. One is mentioned by Wharton and 
Stille, where, after thirty-eight days' interment, the evidence 
of strangulation was obtained chiefly from the striking con- 
trast .of the integments of the neck with those of the rest 
of the body. There was a white, shriveled space over the 
larynx, half an inch broad ; also a groove around the neck, 
of a blackish-brown color and parchment-like appearance ; 
this condensed skin was difficult to cut, and its section was 
perfectly dry and yellowish-white. Another remarkable 
case occurred in Paris, where the body had been buried 
several years, and was reduced almost to a perfect skeleton. 
Several of the cervical vertebrae, together with the right 
clavicle, were found held together by a blackish mass, in 
the composition of which no tissue could be recognized. 
This mass was surrounded by several twists of a cord two 
lines in diameter. The cord was much decayed, showing 
no knots, and its direction was horizontal. The above facts 
enabled Orfila and others to decide that the woman had per- 
ished by strangulation. Another remarkable case is reported 
in which a body partially burned showed evidence of pre- 
vious homicidal strangulation in the peculiar horizontal mark 
encircling the neck, and in the protrusion of the tongue. 

The case of the Commonwealth of Pennsylvania vs. 
Cutaire, tried in 1896, in Philadelphia, is interesting in this 
connection. A carpenter, in repairing a house in the north- 
ern part of the city, found a skeleton under the kitchen 



HANGING. I 5 I 

floor. There were some fragments of clothes and jewelry 
and a silk handkerchief which had been tied around the 
neck in a double knot. The bones were promptly identified 
as those of a woman who had disappeared some fourteen 
years before. As a result of careful detective work, a man 
was arrested, tried, and convicted of the murder. He was 
a boy of about fifteen at the time the woman disappeared. 
He made a confession declaring that he buried the body, but 
denied that he killed her. Much legal controversy occurred 
in regard to the case and the prisoner up to the present time 
(August, 1905) is still in jail. 

Hanging is that mode of death caused by suspension of 
the body by the neck, the weight of the body acting as the 
constricting force. Physiologically, it is the same as stran- 
gulation, and, like the latter, the cause of death is partly 
apnea and partly cerebral congestion, and more frequently 
a combination of the two. 

If the cord encircles the neck below the thyroid cartilage 
the death is more rapid, and is to be ascribed to apnea ; 
but if higher up, as in executions, where it is apt to slip 
under the chin, some little space on either side may escape 
constriction, so as to admit a slight amount of air into the 
lungs ; in this case, the death will be slower, and be due 
rather to cerebral congestion. In the great majority of 
cases, however, as shown by the above table, the cause of 
death is of a mixed nature. In some cases of public execu- 
tions, in which the fall was very considerable, and in which 
a violent rotary swing was given to the body of the criminal 
at the moment of the drop, the odontoid process of the 
second cervical vertebra has been found either fractured or 
dislocated, causing immediate death, owing to pressure 
on the spinal cord, But death, in hanging, from fracture of 



152 MEDICAL JURISPRUDENCE. 

the vertebra, is far less frequent than is supposed. Orfila 
states that in the bodies of fifty persons who had been 
hanged, he met with a fracture of the os hyoides in only 
one case, while he had never met with a fracture or luxation 
of the vertebrse. 

Unconsciousness very speedily supervenes in hanging, 
from the circulation of unaerated blood, especially if the 
trachea is compressed, and death occurs in a very few 
minutes. Persons who have been cut down after a few 
minutes' suspension are very rarely resuscitated. And even 
after an apparent partial recovery, death often follows from 
secondary effects, especially from congestion of the brain. 

The insidious manner in which the loss of consciousness 
steals upon the brain in hanging deserves especial notice, 
because it satisfactorily explains the facility with which 
death takes place, even when the suspension of the body is 
not complete, but when there has been simply a pressure 
of the ligature against the windpipe, the person meanwhile 
resting on the knees or toes, or being in a semi-recumbent 
posture. 

Post-mortem Appearances. — In the main, they resemble 
those attending death from strangulation. Externally, swell- 
ing and lividity of the face, congestion of the eyelids, dilated 
pupils, eyes red and protruding, tongue swollen, livid, often 
protruded, or compressed between the teeth, lower jaw re- 
tracted ; often a bloody froth escaping from the mouth and 
nostrils. There are frequently petechial effusions on the 
neck, shoulders, arms, and hands. In many cases, how- 
ever, especially in suicides, the countenance is calm, the face 
pale, the eyes and tongue natural. Sometimes there is 
turgescence of the genital organs, and an involuntary escape 
of the urine, feces, and semen; but these signs are by no 



SIGNS OF HANGING. 153 

means peculiar to death by hanging. The position of the 
head varies according to the part of the neck where the knot 
was placed. As the latter is usually behind the neck, the 
head is generally flexed forward. If the knot were in front, 
the head would be found extended backward (Tardieu). 
The hands are generally closed, often tightly ; the legs ex- 
tended, and often livid. The neck is nearly always stretched, 
owing to the weight of the body, and it presents very 
decided marks of the cord, varying, however, somewhat 
according to the nature of the latter and its mode of appli- 
cation. Thus, the mark may be deep or superficial, single 
or double, according to the strain made upon it, and the 
thickness, roughness, or duplication of the cord. The skin 
under this mark becomes very dense and tough, and of a 
yellowish-brown color, and has been aptly compared to old 
parchment. This appearance is more marked if the body 
has remained suspended for some hours or days ; and the 
cellular tissue underneath is also condensed, and has a 
silvery appearance. Besides the above, there is often a 
livid mark (ecchymosis), where great violence has been 
used, as in executions ; but the latter is quite distinct from 
the true mark of the cord, with which it has been con- 
founded. The livid line is much less frequently met with 
than was formerly supposed. 

The groove or furrow in the neck, in the great majority 
of cases, will be found between the chin and larynx. Lu- 
taud states that it is above the larynx in nearly four fifths 
of the cases, and over the larynx in the other fifth. Only 
twice has it been found below the larynx. Its direction is 
oblique (which distinguishes it from strangulation) ; it may 
also be double (arising from a double fold of the cord), and 
irregular or interrupted. It is more marked in front, less so 



154 MEDICAL JURISPRUDENCE. 

at the sides and below the ears, and ceases behind. In 
general, the narrower the ligature, and the longer the sus- 
pension, the deeper the furrow. A broad leather thong, 
pressing only by its borders, might produce a double mark. 

Internally, the appearances usually accompanying as- 
phyxia are met with, such as engorgement of the lungs, 
right side of the heart, and venous system, with dark fluid 
blood. Both ventricles of the heart contain blood, if the 
death has been caused by apoplexy ; if by asphyxia, the left 
cavities are found empty, while the right side of the heart 
and the large vessels are engorged with blood. The sub- 
pericardial ecchymoses of Tardieu are not observed. The 
lining membrane of the larynx and trachea is deeply con- 
gested, as in strangulation, and is sometimes coated with a 
bloody froth, though less so than in strangulation and suffo- 
cation. The vessels of the brain are generally congested, 
but extravasation of blood into the brain or upon its mem- 
branes is extremely rare. The brain itself, when cut into, 
presents numerous bloody points. The kidneys are usually 
congested ; the stomach frequently presents evidences of such 
deep congestion as to suggest the idea of an irritant poison. 
The same is true also of the intestines. Yellowly found 
coagulated blood on the mucous membrane of the stomach 
in two out of every five cases of death by hanging. 

An exception to the engorgement of the lungs in hang- 
ing is recorded by Dr. Wilson, of Birmingham, Ala. The 
case was that of a negro aged 22 years. The heart ceased 
beating twelve minutes after the drop fell. The post-mor- 
tem, made one hour afterward, showed the lungs to be 
completely collapsed, though otherwise normal ; the pleural 
cavities entirely free from fluid ; right heart distended with 
dark blood. Stomach deeply congested, and containing a 



SIGNS OF HANGING. I 55 

small amount of blood. Liver and kidneys engorged, and 
brain congested. The above appears to be the second 
recorded case of collapsed lungs in death from hanging, the 
other case being that mentioned by Dr. Massey, of Not- 
tingham, England, of an executed criminal, whose lungs 
were found in a state of extreme collapse. 

Among the occasional lesions may be mentioned fracture 
of the hyoid bone and thyroid cartilage, and rupture of the 
internal and middle coats of the common carotid artery. 

An important question is — Was the death caused by 
hanging? This cannot always be satisfactorily determined 
by mere medical evidence, since there are no positive or 
characteristic signs of this kind of death. The mere sus- 
pension of the body is no proof, since a murderer might 
easily suspend the body of his victim, in order to divert 
suspicion from the true cause of death. The mark of the 
cord can be imitated by suspending a dead body by the 
neck immediately after death, and, according to Casper, 
even up to seventy-two hours after, especially if the body 
be forcibly pulled downward. The livid or ecchymosed line 
is less likely to be found under these circumstances than 
the brownish, parchment-like furrow. Hence, it follows 
that the mark of the cord cannot be regarded as positive 
evidence of death by hanging ; and the other usual signs, 
such as turgescence and lividity of the face, congested eyes, 
swollen tongue, etc., are all met with in strangHng and 
other forms of death, while these very signs may be absent 
in certain cases of hanging. Dr. R. F. Hutchinson states 
that an invariable sign of death from hanging is the flow 
of saliva out of the mouth, down the chin, and straight down 
the chest. The appearance is unmistakable and invariable, 
and could not occur in a body hung up after death, the 
secretion of saliva being a living act. 



156 MEDICAL JURISPRUDENCE. 

To determine the question whether the hanging was sui- 
cidal, homicidal or accidental, regard must be had to the 
attending circumstances ; remembering always that hanging 
is a frequent method of suicide. Out of 368 cases of suicide 
occurring in Berlin, 189 resulted from hanging. Hence, the 
presumption is always in favor of suicide ; besides the diffi- 
culties that would attend an attempt at murder by this 
means. If, however, the body exhibit evidences of great 
violence externally, denoting a struggle and the presence of 
several persons, or marks of the fingers about the throat, or 
of internal laceration, these would be more consistent with 
homicide. The position of the body will throw very little 
light upon the question, since it is fully demonstrated that 
complete suspension is not necessary to produce death. In 
numerous instances the body has been found, after death, 
resting upon the knees, the toes, or the buttocks, or semi- 
recumbent, and in one case entirely supported by the bed- 
stead, while the neck rested in a loop of leather. 

Even if the hands and feet are found tied, the inference is 
not warranted that the act was homicidal;, since determined 
suicides have been known to perform this very act previous 
to hanging themselves. Nevertheless, if a person be found 
with his hands and feet tied, and suspended from a position 
which obviously he could not have reached himself, the 
presumption of homicide would certainly be justified. 

The age of the deceased might be supposed to assist in 
solving the question. If a very young person were dis- 
covered dead from hanging, it would naturally be attrib- 
uted to homicide or accident; yet numerous instances have 
occurred in this country, within the last few years, of sui- 
cidal hanging in children not over twelve or fourteen years 
of age. 



HANGING — SUICIDAL, HOMICIDAL, OR ACCIDENTAL. I 5/ 

Cases of accidental hanging are of occasional occurrence, 
especially among children, who have, while swinging or 
otherwise playing, accidentally become entangled in a noose 
or loop of cord, which was then drawn tightly enough 
around the neck to strangle them. 

Drowning is that special form of death by suffocation in 
which the breathing is arrested by water, or some other 
liquid, and even more, effectually than by a ligature drawn 
around the neck. It is not necessary that the whole body 
should be submerged in order to cause death by drowning. 
This may be accomplished by merely immersing the face, 
so as to keep the nose and mouth under the liquid, as is 
witnessed in the case of drunkards, epileptics, and very 
young children falling with their faces into very shallow 
pools, and perishing from inability to extricate themselves. 
In drowning, in addition to the usual cause of death by 
asphyxia — the deprivation of air — there is superadded the 
physical impediment of the introduction of water into the 
minute air-tubes and vesicles of the lungs by aspiration, in 
the violent efforts of the person to breathe. This is demon- 
strated by the experiments made by the Committee of the 
Medico-Chirurgical Society of London. Two dogs of the 
same size were submerged at the same moment, but one 
had his windpipe plugged, so as to prevent the ingress of 
both air and water, while the other had not. After two 
minutes they were taken out together; the one with the 
windpipe plugged recovered at once on removing the plug ; 
the other died. In three experiments dogs with their wind- 
pipes plugged were kept under water four minutes, and re- 
covered perfectly on being taken out. On inspecting the 
bodies of the animals, the difference was at once manifest. 



158 MEDICAL JURISPRUDENCE. 

In those that were simply deprived of air by plugging the 
windpipe, the lungs were congested ; but in those that had 
been submerged in their ordinary condition — i. e., actually 
drowned — the lungs, besides being congested, exhibited in 
their bronchial tubes and air vesicles a bloody, frothy mucus, 
which completely filled the air vesicles and small tubes, 
forming a mechanical impediment to the ingress or egress 
of air. The lungs were sodden with water, heavy, soft, and 
doughy to the feel, and pitted on pressure of the finger. In 
the lungs of animals that recovered after a short submer- 
sion, very little, if any, of this mucous froth was found ; its 
amount was always proportionate to the time of submer- 
sion. There is no doubt that this froth is produced by the 
violent efforts to breathe which are made within a minute 
after submersion. 

Hence, the probability of recovery after drowning is 
mainly dependent upon the quantity of this mucous froth 
existing in the air-tubes and vesicles of the lungs, and also 
of the water that has penetrated into the substance of the 
lungs. If the quantity is large, the result is almost cer- 
tainly fatal ; if it is small, there is always good hope of re- 
covery. Asphyxia occurs in a minute to a minute and a 
half after submersion, being occasioned by the circulation 
of the unaerated blood, though actual death is postponed 
for a minute or two longer until the heart ceases to beat. 
If the submersion has been complete for four minutes, the 
case may be considered hopeless, unless syncope had oc- 
curred at the moment of entering the water. This, by par- 
tially suspending the attempts at respiration, would un- 
doubtedly tend to prolong life for some minutes longer. 
Cases are reported of resuscitation after being fifteen minutes 
under water; but these are exceptional, and were probably 



DROWNING. 159 

cases of syncope, occurring at the moment of submersion. 
It should be remembered that the heart may continue to 
beat some minutes after respiration has ceased ; but, in the 
present instance, the pulsation of the heart is no criterion 
of the power of recovery, on account of the physical im- 
pediment in the lungs just alluded to. 

Taylor gives the following excellent synopsis of the cir- 
cumstances attending a case of drowning : " When a person 
falls into the water and retains his consciousness, violent at- 
tempts are made to breathe ; at each time that he rises to 
the surface, a portion of air is received into the lungs ; but 
owing to the mouth being on a level with the liquid, water 
also enters and passes into the throat. A quantity of water 
thus usually enters the mouth, which the drowning person 
is irresistibly compelled to swallow. In his efforts to breathe 
while his head is below the water, a portion of this liquid is 
drawn into the air- tubes and cells of the lungs. The 
struggle for life may continue for a longer or shorter period, 
according to the age, sex, and strength of the person; but 
the result is that the blood in the lungs is imperfectly 
aerated, the person becomes exhausted, and insensibility 
follows. The mouth then sinks altogether below the level 
of the water ; air can no longer enter the lungs ; a portion 
of that which they contained is expelled, and rises in bubbles 
to the surface; an indescribable feeling of delirium, with a 
ringing sensation in the ears, supervenes ; the person loses 
all consciousness, and sinks asphyxiated. In the state of 
asphyxia, while the dark-colored blood is circulating, con- 
vulsive movements of the body take place, and the contents 
of the stomach are sometimes ejected by vomiting. There 
does not appear to be any sensation of pain ; and, as in the 
other cases of asphyxia, if the person recovers, there is a 
total unconsciousness of any suffering." 



l6o MEDICAL JURISPRUDENCE. 

Even after resuscitation from drowning, death frequently 
takes place within a few hours or days from secondary 
causes, as exhaustion, obstruction to respiration from the 
condition of the lungs, convulsions, and spasm of the 
glottis. 

Signs of Death by Drowning. — i. External. These vary, 
according to the length of time the body has been in the 
water, and the interval after it was taken out. Supposing 
the immersion not to have been over two or three hours, 
and the inspection to be made immediately, the face will 
be found to be pale, the expression placid, the eyes half 
open, the eyelids livid, and the pupils dilated, the mouth 
half closed or open, the tongue swollen and congested, often 
indented by the teeth, and perhaps lacerated; the lips and 
nostrils covered with a mucous froth, which issues from 
them. The skin is cold and pale, and generally contracted 
so as to present the appearance called " goose-skin." This, 
being a vital act, is a pretty sure sign that the body was 
living when immersed in the water. It is not dependent on 
cold, as was at one time supposed. Cadaveric rigidity usu- 
ally comes on early in the drowned, hence the body is often 
found with the limbs stiffened. Retraction of the penis is 
considered by Casper and Kanzler as a positive sign of 
drowning. 

Besides the above, there are sometimes seen marks of 
abrasion on the body, especially on the hands, together with 
sand, gravel, or mud under the nails, weeds, pieces of wood, 
or other matters locked in the hands, all of which would 
seem to indicate that the person had been alive when first 
immersed in the water; although the abrasions might very 
possibly have resulted from the body rubbing against some 



SIGNS OF DROWNING. l6l 

rough substances after death. After several days' immer- 
sion, the palms of the hands and soles of the feet become 
white, thickened, and sodden, the result of imbibition. 

If putrefaction has commenced before the body is removed 
from the water, the face will have assumed a reddish, or 
bluish-red coloration. 

2. Internal. — Along with the usual evidences of death 
from asphyxia (in an early examination) the following signs 
will be observed: the lungs are distended, overlapping the 
heart, and are in a flabby condition ; this latter is owing to 
the water taken in by aspiration, during the struggles for 
breath, which penetrates even the air vesicles, and renders 
them sodden and doughy. When cut into, the lungs exude 
a bloody, mucous froth. The presence of this froth in the 
smaller tubes and air cells, together with the sodden con- 
dition of the lungs, is regarded as one of the most positive 
signs of death by drowning. Nevertheless, its absence 
should not be accepted as a proof against drowning, since 
it has not been found in the bodies of persons who have 
sunk at once in the water, and never risen to the surface to 
breathe. Ogston states that in 48.7 per cent, of cases, no 
water was found in the lungs, and he accounts for its ab- 
sence by its transudation from the lungs into the pleural 
cavities, where it was found in quantities varying from one 
to thirty-four ounces. In a case examined by Dr. Reese a 
few years ago, the body of a woman taken out of the 
Delaware, there was an absence of this characteristic froth 
in the minute bronchial tubes, and also of the peculiar 
flabby condition of the lungs. The absence of these pecu- 
liarities in the lungs of the body of Jennie Cramer, at New 
Haven, created a feeling in the minds of many that it was 
not a case of suicide by drowning, but that the girl was 

15 



1 62 MEDICAL JURISPRUDENCE. 

murdered before the body was thrown into the water. The 
discovery of a considerable amount of arsenic in the body 
of the deceased was sufficient to account for the death. 
These peculiar conditions of the lungs of the drowned have 
not yet been sufficiently determined. It is quite possible 
that some cases of bodies taken out of the water, and re- 
ported by coroners' juries as " found drowned," may in 
reality have met their death by other means, prior to their 
immersion. It is important to remember that the presence 
of this mucous froth in the air passages is not seen after 
putrefaction, nor after long exposure of the body to the 
air, nor after long immersion. It is also stated to be absent 
in those who remained under the water without rising to 
the surface. These circumstances may account for the fact 
of its occasional non-observance in the bodies of the 
drowned. Devergie and other authorities state that this 
froth is occasionally found in the trachea and bronchi, in 
deaths from other causes. 

Another important indication of death by drowning is 
the presence of water in the stomach, which had been 
swallowed in the act of drowning, especially if this corre- 
sponds with the water in which the body was found. The 
value of this is enhanced if, along with the water, there be 
discovered in the stomach fragments of weeds, sand, mud, 
or other articles, corresponding with the like substances 
existing in the pond or river where the drowning occurred. 
The quantity of water in the stomach varies considerably; 
it was found to be greater in an animal that was allowed to 
come to the surface frequently than in one kept completely 
submerged, because in the latter the power of swallowing 
was sooner lost, in consequence of the early occurrence of 
asphyxia. 



SIGNS OF DROWNING. 1 63 

The absence of water from the stomach is not to be con- 
sidered as disproving a case of drowning, inasmuch as it is 
not present (because not swallowed) in cases where either 
syncope or apoplexy had occurred at the moment of im- 
mersion. 

The mere discovery of water in the stomach is not of 
itself a positive indication of death by drowning, since it 
may have been swallowed before immersion ; but with this 
allowance, and with the restrictions above mentioned, it does 
constitute a very important sign, inasmuch as it has been 
ascertained by experiment that water will not penetrate into 
the stomach after death, unless putrefaction has advanced 
to a great extent ; consequently, its presence indicates 
pretty certainly that it had been swallowed in the act of 
drowning. Orfila's experiments prove that water may pene- 
trate into the larger bronchial tubes after death, but not into 
the air vesicles of the lungs ; besides, in such cases, there 
is no accompaniment of mucous froth in the air tubes. 

The condition of the heart affords no positive indication 
of death by drowning. In the majority of cases, the right 
cavities are full, and the left ones empty, as in asphyxia 
generally ; but very often the two sides are equally full. 

The brain exhibits no characteristic post-mortem sign. 
There may be some general fullness of the vessels, but 
never extravasation of blood, unless a sudden apoplexy had 
supervened, as when a person plunges suddenly into cold 
water after eating heartily, or by striking the head against 
a hard body in the act of diving. 

The blood is usually dark and fluid. The fluidity of the 
blood, according to Brouardel, is owing to the water ab- 
sorbed into the circulation through the pulmonary tissue; 
and this is much more decided in cases where the person 



164 MEDICAL JURISPRUDENCE. 

dies slowly, after coming to the surface frequently, than 
when, through syncope, apoplexy, or drunkenness, he im- 
mediately sinks to the bottom. Brouardel regards the 
fluidity of the blood, the empty condition of the heart, the 
infiltration of the lungs with water and froth, and the 
presence of broad, ill-defined subpleural ecchymoses as in- 
dicative of gradual drowning with struggling ; while, if the 
blood is not fluid, if there are punctated subpleural ecchy- 
moses, and clots of blood in the heart, and rather an absence 
of pulmonary, watery infiltration, he would consider it a 
case of drowning in which there had been no struggle made 
to breathe. The mucous lining of the stomach and bowels 
is usually congested and of a deep violet color if the body 
had been long in the water ; this might lead to the suspicion 
of irritant poisoning, as is seen also in hanging. Occasion- 
ally, in cases of drowning, after a full meal, vomiting occurs, 
and the contents of the stomach are found in the windpipe 
and lungs ; this is a conclusive evidence that the person must 
have been alive at the time. 

The time at which the bodies of the drowned will float 
varies with the temperature of the air, the water, the age, 
sex, and corpulence. As the human body is slightly heavier 
than water, it must remain submerged until it becomes 
lighter through the development of the gases of putrefac- 
tion. Hence, in summer the body may rise within twenty- 
four hours. In salt water it will float sooner than in fresh ; 
very fat bodies float sooner than lean ones ; the bodies of 
women and those of young children sooner than those of 
men. Hence, in infanticide by drowning, the infant's body 
speedily rises to the surface. 

To determine the time that has elapsed since the act of 
drowning, when the body is discovered in the water, is not 



SIGNS OF DROWNING. 1 65 

always possible. After putrefaction has set in, it is mere 
guesswork. The most certain criteria to guide the ex- 
aminer are the presence of the mucous froth in the air- 
tubes and cells, and the presence of water in the lung tissue, 
both of which indications disappear after exposure to the 
air and after putrefaction. Hence, the importance of an 
early inspection. Devergie, who has given particular atten- 
tion to this subject, offers the following observations : 
During the winter, for the first three days there is no change. 
From three to five days there is cadaveric rigidity ; the 
palms of the hands begin to blanch. From four to eight 
days the limbs become supple, but still retain their natural 
color ; the palms of the hands are very white. From eight 
to fifteen days the face, at first pale, becomes red in places 
and bloated; the skin on the back of the hands and on the 
feet is blanched; a greenish appearance at the base of the 
sternum. In one month the skin on hands and feet is very 
white and in folds, the face reddish-brown, the eyelids and 
lips greenish, with a reddish-brown patch, surrounded by a 
greenish zone on the front of the chest. In two months 
the epidermis of the hands and feet to a great extent is 
softened and detached, the face generally swollen, and of a 
brownish color; hair falling out; nails still adherent. In 
three months, commencing saponification, especially in 
women, about the face and neck, breasts, groins, and thighs ; 
nails loosened. In four months saponification has pro- 
gressed on the face, neck, and thighs, and commenced in the 
brain ; general softening and destruction of the hairy parts 
of the skin. 

If the foregoing observations made in the winter were 
applied to the summer, the following allowances are to be 
made : five to eight hours' continuance in the water in sum- 



1 66 MEDICAL JURISPRUDENCE. . 

mer are equivalent to three to five days in winter ; twenty- 
four hours in summer, to four to eight days in winter ; four 
days, to fifteen days ; and twelve days, to one month, or 
six weeks. 

If marks of violence be found on the bodies of the 
drowned, of course suspicion will be aroused of foul play, 
unless these marks can be satisfactorily attributed to some 
post-mortem cause. A murderer may destroy his victim, 
and then throw the body into a river, pond, or well, with 
the intention to elude suspicion of the real cause of death. 
A close examination of the body for wounds and other 
injuries, together with the absence of the known signs of 
drowning, will generally enable the examiner to form a 
correct conclusion. Tardieu regards the presence of sub- 
pleural ecchymoses, together with subpericranial and sub- 
pericardial effusions^ as indicative of a preceding suffocation. 

Throwing into rivers or pools is a very common method 
of disposing of bodies in cases of infanticide. 

The question of accident, homicide, or suicide, in the case 
of drowning, must claim the attention of the legal physician. 
Homicidal drowning is rare, except in the case of infants. 
It is denoted by the marks of violence on the body, which 
cannot be explained by any post-mortem influence. It 
should be remembered that determined suicides frequently 
inflict dangerous wounds upon themselves, and then termi- 
nate their lives by drowning. Such cases might possibly 
be mistaken for homicide. The presence of the usual signs 
of drowning would at least show that the body was alive at 
the time of immersion. Suicidal and accidental drowning 
cannot always be distinguished from each other ; inferences 
may, however, be drawn from the circumstances attending 
the cases, as the existence of a motive to suicide, or a ten- 



SIGNS OF DROWNING. 1 6/ 

dency thereto through melancholia. The proximity of a 
precipice, or other dangerous place, to the water in which 
the deceased was found, would naturally suggest accident, 
especially in the case of a child. The tying of the hands 
and feet of a person found dead in the water is no proof of 
homicide, since many instances are recorded of suicides so 
binding themselves, and of attaching heavy weights, before 
throwing themselves into the water. 

The restoration of the drowned depends chiefly on excit- 
ing artificial respiration. The clothes should be immediately 
removed, and the body quickly wiped dry and wrapped in 
a blanket ; clear the mouth and nostrils of mucus and 
water ; draw forward the tongue ; place the body with the 
face downward, the forehead resting on one arm, for a few 
moments, to allow the fluids to run out of the mouth ; apply 
ammonia cautiously to the nose. If respiration is not re- 
stored, placed the body on the back, with the head raised, 
and adopt Sylvester's process of artificial respiration, by 
carrying the arms gently outward and upward above the 
head for a few seconds ; this movement expands the chest. 
Then lower the arms and bring them to the sides of the 
chest ; by this action expiration is effected. These alter- 
nate movements should be made each about every two 
seconds. All rough handling, such as the vulgar plan of 
rolling on a barrel, should be avoided. As soon as any 
signs of respiration are manifested, warmth should be 
applied to the skin by a warm bath or stimulating friction. 
When able to swallow, the patient may take a little warm 
spirit and water, and then be put to bed and allowed to 
sleep. This treatment has been rewarded with success, 
after being persisted in for some hours. 



1 68 MEDICAL JURISPRUDENCE. 

DEATH BY ELECTRICITY. 

Death caused by Lightning is often accompanied by 
results which resemble very strongly the effects of homi- 
cidal violence. 

Experience shows that persons out of doors^, especially 
under trees, are much more liable to be struck by lightning 
than those within doors. 

The fatal effects of lightning are usually instantaneous, 
death being caused by shock. At times, however, it pro- 
duces lesions of the brain and spinal cord, such as epilepsy, 
paralysis, effusion of blood, tetanus, etc., which may subse- 
quently prove fatal. Generally speaking, if death does not 
follow immediately, or soon after, there may be hopes of 
recovery. 

The visible effects produced by a fatal lightning stroke 
are remarkably varied. Sometimes, a deep, punctured or 
lacerated wound will indicate where the fatal blow was 
struck, upon the head, neck, or other part of the body ; the 
hair may be singed, or burnt off ; the clothing may be burned 
or completely stripped off; the boot may be split open. 
Again, the course of the electric current may be marked 
by a deep or superficial burn, extending from the point of 
entrance, down and around the body, to the ground. If 
there should happen to be any metallic substances in con- 
tact with the body, such as chains, coins, a watch, etc., as 
these are good conductors of the electric current, it will be 
certain to include them in the circuit, and they will be fre- 
quently found to have been melted. 

In other cases of death by lightning, no external wound 
or burn may be visible. Sometimes there may be severe 
external injuries, while the clothes entirely escape. Again 
the clothing may be completely torn off the body, while the 
latter exhibits no injury whatever. 



DEATH BY LIGHTNING. 1 69 

The capricious action of the discharge is shown by the 
fact that out of a party of three or four sitting under a tree, 
one or two only may be killed, and the others escape. 
Again, it has occurred that persons under a low tree have 
been struck, although high trees, and a lightning rod, and 
an iron bridge were near. Again, the same discharge may 
produce in one person wounds, and burns in another. The 
diversity of its action on the clothes may probably be 
explained by the circumstances of a portion of the clothing 
being wet, and a portion dry; the former, being a good 
conductor, might escape the disruption which would be 
exhibited by the dry portion, which is a bad conductor. 

Post-mortem Appearances. — In case of instantaneous 
death, the body may be found in the exact attitude in which 
it was struck. Some remarkable instances of this are re- 
corded in the books. In such cases, the rigor mortis occurs 
immediately after death. Hunter supposed that there was 
an absence of the usual rigidity after death ; but in this he 
was in error. Coagulation of the blood also occurs, although 
it is delayed. The face is often bloated and discolored, and 
putrefaction is usually very rapid. Wounds of various 
character are observed — contused, lacerated, and punctured ; 
also burns, vesications, and ecchymoses ; these latter some- 
times exhibit a remarkable arborescent appearance. Occa- 
sionally, fractures of the skull and of other bones are noticed. 
The blood is dark and fluid. 

The brain and its membranes generally suffer most 
severely, the head being usually the first part struck. Con- 
gestion of the brain, effusion of blood under the skull and 
into the ventricles, and even complete disorganization of the 
brain substance have all been observed. The lungs are 
sometimes found congested and injured, and the air-tubes 
16 



170 MEDICAL JURISPRUDENCE. 

full of mucus. The stomach, intestines, liver, and spleen 
are also usually much congested. The heart does not ex- 
hibit any special alteration. 

The medico-legal interest, in cases of death from light- 
ning, is centered in the question of being able to identify 
such cases, and to distinguish them from those of homicidal 
violence. A close observation of all the circumstances of 
the case — such as the occurrence of a thunder-storm about 
the time of the death, the peculiar appearance of the wounds 
and burns, especially if the two co-exist on the same body, 
the half-melted appearance of metallic articles, such as 
buttons and coins, on the person of the deceased, etc., — 
will tend to throw much light upon it. 

The introduction of electricity into very general use, in 
civilized countries, as a source of illumination and as a 
motor force, has been the occasion of numerous fatal re- 
sults, arising from the accidental contact of individuals with 
the detached conducting wires employed. These deaths have 
sometimes been accompanied with excessive burning of the 
bodies of the unfortunate victims, at the points of contact 
of the wires. 

Electric currents may be either continuous or alternating. 
In the former (sometimes called " direct ") the current flows 
constantly in the same direction ; in the latter, there are 
rapid changes in direction, usually more than one hundred 
a second. Sometimes the electric current is sent in multiple 
impulses ; these are called polyphase currents. It is gener- 
ally thought that alternating are more dangerous than 
direct currents of corresponding voltage. Incandescent 
systems are often run on no or 220 volts, and are not suf- 
ficient to do serious harm. Trolley-car lines are usually 
supplied with a continuous current at about 600 volts which 



DEATH BY LIGHTNING. I7I 

is dangerous. Street arc-lamps are almost always supplied 
at high pressure, often several thousand volts, and alternat- 
ing currents are largely used in such installations. These 
are the most frequent causes of death. In Philadelphia, a 
man was instantly killed by accidentally touching the end 
of an umbrella to the lower portion of an arc-lamp. 

Subjection to currents of high intensity has been made 
the means of execution in the State of New York, and has 
been applied in a number of cases. The absurd term 
" electrocution," invented by newspaper reporters, has been 
applied to this method. The prison authorities of New 
York are apparently satisfied with the system. 

It must be borne in mind that while telephone wires do 
not carry dangerous currents, they may at any time be 
charged to a fatal extent by contact with wires carrying 
heavy currents. Another source of danger is that alternating 
currents of high voltage used for indoor service, such as 
incandescent lights and fans, are reduced to very low voltage 
by transformers, but these may get out of order and allow 
the full pressure street current to pass into the house wires. 

DEATH FROM HEAT AND COLD. 

The effects of extreme Heat on the human system are 
familiarly witnessed in tropical and semi-tropical climates, 
during the heated term, in the mortality arising from what 
is popularly denominated sunstroke. In such cases, the 
dangerous and fatal results are attributable directly to solar 
heat. But effects equally serious are known to be produced 
by exposure to artificial heat, if too long continued, as is 
witnessed in those employed in engine-rooms, factories, etc., 
where a very high temperature is habitually maintained. 
There would seem to be, according to the observations of 



1/2 MEDICAL JURISPRUDENCE. 

Wood, three distinct conditions of the human body occa- 
sioned by excessive heat; in the first (which is rare), we 
have acute meningitis or phrenitis (sunstroke) ; in the sec- 
ond, we have heat-exhaustion with collapse, accompanied 
by a rapid, feeble pulse, a cool, moist skin, and a tendency to 
syncope ; in the third, we have true thermic fever — that con- 
dition which results especially from exposure to artificial 
heat. But something more than mere heat is required to 
produce thermic fever. It does not occur in a perfectly 
pure and dry atmosphere, because the profuse perspiration 
which is immediately developed by its rapid evaporation 
keeps the temperature of the body down nearly to the nor- 
mal standard. If, however, the air is already saturated with 
moisture, this will prevent the evaporation from the body, 
and its temperature will rise to a dangerous height. 

The symptoms vary in intensity, from a mere headache 
with drowsiness, to complete insensibility, coma, and pa- 
ralysis. In many instances, death appears to be caused by 
paralysis of the heart. 

The post-mortem appearances are by no means constant. 
In some cases (true sunstroke) we find decided congestion 
of the brain and its membranes, with serum in the ventricles, 
together with congestion of the lungs and of the abdominal 
viscera generally, and the heart as in ordinary death from 
asphyxia. In other cases, there is anemia of the substance 
of the brain, along with distention of the larger vessels with 
dark, fluid blood, but the minute vessels empty. 

Cases of insolation do not often claim the attention of the 
legal physician, yet as they might occur remote from wit- 
nesses, and with a fatal termination, it is proper that the 
medical examiner should understand their nature, together 
with the ordinary accompaniments. 



EFFECTS OF HEAT AND COLD. 1 73 

The effects of Cold upon the animal body are immediately 
depressing ; but if it be of short duration, and the system is 
in good health, reaction takes place. The human body has 
the power to maintain its normal temperature of about 
98.6° F. independently of thef external temperature. It has 
been ascertained by actual experiment that a warm-blooded 
animal will not survive if its temperature is reduced down 
16 to 20 degrees below the normal. There is no authentic 
account of the recovery of a warm-blooded animal, much 
less a human being, after the whole body was frozen, al- 
though fishes and other of the lower animals are said to 
have been resuscitated from a frozen state. 

Death from cold is hastened by whatever exhausts the 
system, as fatigue, both bodily and mental, loss of rest, want 
of proper food and nourishment, mental depression, and 
particularly intoxication. A damp cold (such as wet cloth- 
ing) is more dangerous than a dry one. The fatal effects 
of exposure to cold are witnessed, even in comparatively 
temperate climates, during the winter, in the cases of the 
destitute, and especially where this condition is associated 
with intemperance. 

Cases of death from cold do not often require the atten- 
tion of the medical jurist. There are, however, certain con- 
ditions under which they may occur which demand a brief 
consideration. 

Every body in which it is assumed that death has taken 
place from exposure to cold should be examined as soon 
as found to determine the proofs of death. Herris records 
a case in which an infant was removed to an undertaker's 
establishment, presumably dead ; many hours afterward, — 
the exact time is not given, — when he called to make the 
autopsy and while in conversation with the undertaker in 



174 MEDICAL JURISPRUDENCE. 

an adjoining room, their attention was attracted by the 
crying infant, which by energetic efforts was completely 
resuscitated. 

A not infrequent form of infanticide is the exposure of a 
new-born child to very cold •air. Death will soon ensue 
under such circumstances, since the infant's power of resist- 
ance to cold is limited. In such a case it will be the physi- 
cian's duty to examine the body of the child and consider 
the accompanying circumstances, such as the place where 
it was found, the temperature of the air, the possibility of 
its being accidental, etc. As regards the body, he should 
notice if the pallor is extreme; if frozen stiff, he should 
distinguish this rigidity from rigor mortis ; also the arterial 
color of the blood ; the accumulation of blood on both sides 
of the heart and in the larger vessels. There may also be 
marks of violence upon the body. 

Occasional instances of the exposure of young children 
to cold with homicidal intent are recorded. Such a case is 
related of two inhuman parents causing the death of a 
daughter, aged eleven years, by compelling her to get out 
of bed on a very cold night and place herself in a vessel of 
ice-cold water. 

In the treatment of the insane, the barbarous and im- 
proper use of the cold shower bath for reducing intractable 
patients to submission was formerly much more in vogue 
than at present. It need hardly be said that such treat- 
ment is extremely hazardous, and it has been followed by 
fatal results. Taylor records an instance of a lunatic, aged 
sixty-five, who was subjected to a cold shower at 45° F., 
and who afterward took a dose of tartar emetic ; he died in 
fifteen minutes subsequently. Cases of this character would 
very properly come under the notice of the legal authorities. 



DEATH BY STARVATION. 1/5 

Post-mortem Appearances. — These cannot be considered 
as very characteristic; hence, the examiner should be cau- 
tious in deciding, in any given case, as to whether exposure 
to cold was the primary cause of death. All the circum- 
stances of the case here require special consideration, such 
as the season of the year, the temperature of the air, the 
place of exposure, etc. Rigor mortis generally sets in 
slowly and lasts a long time. According to Ogston, the 
four following appearances, in the absence of any other 
obvious cause, would justify the conclusion that the death 
had resulted from cold, although the signs were not so well 
marked in children as in adults : 

1. An arterial hue of the blood, except when viewed 
in mass within the heart; some exceptions are, however, 
noted. 

2. An unusual accumulation of blood on both sides of 
the heart. 

3. Pallor of the general surface of the body and con- 
gestion of the viscera most largely supplied with blood. In 
some cases, the congestion of the brain and liver was only 
moderate. 

4. Irregular and diffused dusky-red patches on limited 
portions of the exterior of the body, even in non-dependent 
parts (distinguishing them from suggillations). 

As putrefaction does not occur at a freezing temperature, 
the discovery of a decomposing corpse in the ice or snow 
would afford very strong, though not absolutely conclusive, 
evidence that the death was not the result of exposure to 
cold, but rather that the body had been frozen after death. 



1/6 MEDICAL JURISPRUDENCE, 

DEATH BY STARVATION. 

Cases of death by Starvation are of sufficiently frequent 
occurrence to merit the notice of the medical jurist. Acute 
starvation implies the sudden and complete deprivation of 
all food. Chronic starvation is the result of a continued 
deficient supply of food, both in quantity and quality. Homi- 
cidal death from acute starvation is very rare ; but cases 
of accidental death from this cause are sufficiently nu- 
merous, as in the instances of miners buried in the earth, 
shipwrecked mariners, and others cut off from food. Oc- 
casionally, prisoners and lunatics will undertake to commit 
suicide by voluntary abstinence from all food ; in the 
majority of cases, however, courage fails after some days' 
experience and they give up the attempt. 

Many cases of voluntary fasting which have claimed the 
notice of the public during the past years have proved, on 
close examination, to be deceptions, food and drink having 
been supplied surreptitiously to the individuals concerned. 
Among these instances may be mentioned the case of Ann 
Moore, of Tetbury, England, who was alleged to have 
abstained from all food from 1807 to 1813. Another case 
was that of the Welsh Fasting Girl, aged thirteen years, 
who is stated to have absolutely fasted for two years. Both 
these cases were shown to be impostures. The notorious 
Dr. Tanner, of our own country, undertook, for a consider- 
ation, to perform the feat of a forty days' absolute fast, in 
New York, in August, 1880, and, to all appearance, he 
accomplished it. It is stated that during all this time he 
partook of nothing save some ounces of pure water each 
day, and that his loss of weight at the end of forty days 
was thirty-six pounds. The fluctuations in his pulse, tem- 



DEATH BY STARVATION. I 77 

perature, and respiration were unimportant. This case was 
not under very strict medical supervision, and the doubt as 
to its genuineness seems to be confirmed by the fact of his 
voracious feeding on the completion of the fast, unattended 
by any bad effects, which is contrary to the general expe- 
rience of others who have been deprived of food for a 
length of time. Since the above case, several instances are 
recorded of voluntary fasting for periods varying from 
several weeks to some months ; but there is nearly always 
some uncertainty as to absolute fasting. 

Chronic starvation, as the result of disease, is a frequent 
cause of death, as is witnessed in stricture of the esophagus, 
cancer, and other disorders of the stomach and bowels, dis- 
ease of the pancreas, marasmus, etc. It is likewise the 
cause of disease and death in young children fed upon un- 
suitable milk, as when this fluid is deficient in some of its 
proper constituents. Such cases are abundantly illustrated 
in the miserable victims of baby-farming. Chronic starva- 
tion is also witnessed on a large scale in districts where 
famine has prevailed, as in certain parts of India, and in the 
Irish famine of 1847. 

The symptoms of chronic starvation are generally well- 
marked. The sense of hunger is not very urgent ; emacia- 
tion, especially in the last stages, is extreme; the eyes are 
hollowed, the pupils dilated ; the skin is harsh and dry, and 
hangs loosely over prominent bones, and, in chronic cases, 
becomes covered with a brownish, dirty-looking coating, and 
exhales an offensive odor, like that of putrefaction. The 
bowels are either very constipated or the feces are scanty, 
dry, and dark-colored. There is great muscular debility, 
palpitation, with tinnitus anriiim; pains in the stomach, 
with a dry, parched mouth ; the intellect sometimes clouded, 



178 MEDICAL JURISPRUDENCE. 

but again clear to the end, with despondency of mind. The 
pulse is at first somewhat quickened, afterward it is slower ; 
the temperature is usually below that of health. 

Post-mortem Appearances. — Great emaciation of the body, 
with an almost entire loss of fat; sunken cheeks and eyes. 
The skin shriveled, and emitting a disagreeable odor. The 
muscles soft, pale, and wasted. The brain sometimes con- 
gested, and at others pale and soft, with effusion of serum 
on the surface and in the ventricles ; the lungs healthy or 
anemic ; the heart more or less contracted and void of blood ; 
stomach and intestines contracted, thin, and transparent ; the 
latter usually empty; the bladder contracted and empty. 

As regards the medico-legal relations of starvation, 
although it is rarely the cause of homicidal death, it should 
be remembered that the law does not require the absolute 
deprivation of food to be proved, but only the necessary 
quantity and quality to be withheld, provided this has been 
done with an evil intention. Cases of this character are 
sometimes witnessed in baby-farming. 

Death from poisoning will be treated at length in a 
special section under the title Toxicology. 



CHAPTER VII. 
FEIGNED DISEASES. 

I. Feigned Bodily Diseases. — These become the sub- 
ject of inquiry very frequently, especially among soldiers, 
sailors, and prisoners, who are ever ready to resort to all 
sorts of pretexts to escape duty, to avoid certain kinds of 
punishment, or to secure comfortable quarters in a hospital. 
Among civilians the same fraud is sometimes attempted, as 
in an alleged incapacity to perform military service, to 
undergo imprisonment, or to discharge the duties of a juror 
or witness. Casper remarks : This simulation of disease 
is sometimes carried out by a purely mental effort, as by 
cunning, lying, or mimicry; at others, by the aid of mate- 
rials of various kinds, such as crutches, bandages, trusses, 
cutting instruments, spectacles, etc. All such cases of 
pretended disease are termed fictitious by Dr. Ogston. 
There is another class of cases which are produced by the 
patient at his convenience, or at least are exaggerations of 
some trivial complaint ; these are named factitious by the 
above author. 

The ingenuity of malingerers is almost incredible. Not 
only may they resort, when occasion requires, to all manner 
of disgusting performances, such as swallowing excrement 
or blood, or other offensive substances, but they may actu- 
ally maim or injure various organs for the purpose of gain- 
ing their object. " The greatest difficulty in detecting impos- 
ture arises when we examine the subjective symptoms ; and 
extreme caution is then needed, besides the adoption of 

179 



l80 MEDICAL JURISPRUDENCE. 

the most delicate tests, which should repeatedly be made 
use of until we are satisfied as to what is the real condition 
of the patient." (Hamilton.) 

If we may trust chroniclers, simulated diseases were 
much more common in former times than at present. We 
rarely now note such extraordinary cases of deception as 
are described in old books, of persons vomiting frogs and 
lizards or snakes, passing inky urine, or discharging im- 
mense stones from the bladder, etc. Such instances of 
fraud would soon be detected by the modern means of 
diagnosis. 

It is proper that the physician should understand the 
reasons or motives of the malingerer for feigning disease, 
since these may often aid him in unmasking the decep- 
tion. These motives may be classed under the following 
heads : 

1. Fear. — As, for example, to avoid military service; or, 
in the case of the soldier, to be excused from going into 
battle. According to Beck, the observations of Mr. Lane 
on the modern Egyptians show that the practice of break- 
ing out one or more teeth, or cutting off a finger, or putting 
out an eye, was exceedingly common among the young 
men throughout that country. The same motive influences 
culprits to escape certain species of punishment which they 
have deserved, such as flogging or the treadmill. 

2. Gain. — This is a very prevalent and powerful motive 
to simulate disease, as e. g., to obtain damages for some 
alleged injury, either public or private ; it is often the 
source of groundless charges in railway accidents; to pro- 
cure better quarters, either in a hospital or almshouse; to 
obtain a divorce ; to excite commiseration and aid from the 
benevolent; and in numerous other methods. 



FEIGNED DISEASES. 151 

3. La::{iiess. — As in beggars and others, to escape work 
and live in idleness. 

4. Notoriety. — This is chiefly witnessed in hysterical 
women, who will simulate almost every variety of disease, 
and submit to painful treatment ; who will frequently muti- 
late themselves, and pretend to take poison, or destroy 
themselves in some other manner, and with no other con- 
ceivable motive except to gain notoriety. 

As regards the mode of diagnosis, the following general 
rules may be observed : Cunning and shrewdness must be 
met by the exercise of these same qualities on the part of 
the examiner. In nothing are experience and tact of greater 
assistance to their possessor than in the management of this 
sort of cases. The examiner should always bear in mind 
that simulation may be possible, and that this is likely to be 
practiced in a given case if a sufficient motive exists ; he 
should try to discover this motive, using great caution in 
the attempt. 

One should not be content with a single examination of 
the patient, but should surprise him with an unexpected 
visit, made soon after the first one, and observe him closely 
when he is not aware of notice ; by this means the decep- 
tion may often be discovered when he is off his guard. 

The patient's account of the rise and progress of his dis- 
ease should be compared with known medical facts con- 
nected with the history of the real disorder. It is often 
useful to mention in the patient's hearing certain false 
symptoms of the alleged disease, and afterward ask him 
after these symptoms ; when, if simulating, he will be very 
apt to enact them just as he heard them. One who 
complains of a multitude of ailments should always be sus- 
pected, especially ailments which have no natural connec- 



1 82 MEDICAL JURISPRUDENCE. 

tion with one another. All local ailments should be exam- 
ined with the parts uncovered; all dressings and bandages 
must be removed. The physician should not be misled by 
cicatrices, cupping scars, leech bites, or blisters. No im- 
portance whatever is to be attached to the statements of 
relatives or friends, since they would naturally sympathize 
with the patient. 

Anesthetics (ether and chloroform) may sometimes be 
employed successfully in suspected cases of contracture of 
the spine or muscles. A very successful method is to 
threaten, and even use, some very repulsive medicine or 
remedy, as powerful revulsives, and especially the actual 
cautery; but there are some cases that prove obstinate and 
unconquerable, even under this severe ordeal. 

Special Diagnosis. — Feigned Pain. — There is probably 
no symptom so commonly complained of by the malingerer, 
and none more difficult to determine by the examiner, than 
pain, because it is purely a subjective symptom. Hence, it 
will try the skill and tact of the physician to the utmost. 
A close and patient investigation will, however, usually 
detect the fraud. The simulator will either be too exactly 
correct in his description or else entirely incorrect in his 
localization. He will exhibit great distress under the 
slightest pressure, when his attention is directed to the part ; 
but when this is directed elsewhere, no evidence of pain is 
manifested. Questions or hints, skillfully thrown out, may 
put him off his guard and reveal the deception. A favorite 
seat of pain is the back, and it is usual among soldiers to 
attribute it to rheumatism, contracted by exposure from 
sleeping on the damp ground. Of course, there are some 
real sufferers from this cause, but they are outnumbered by 



FEIGNED DISEASES. I 83 

the simulators. The latter may often be detected by close 
watching when they think they are unobserved. Their 
agility of motion contrasts wonderfully with their lameness 
"and difficulty of movement when they come into court or 
before the medical officer for examination. 

If the pain complained of is very severe and persistent, 
and there is an absence of all other concomitant symptoms, 
there is strong room for suspicion. So, too, if the person 
complains of intolerable pain in executing certain muscular 
movements, but evinces no suflfering when exercising the 
same parts in a way more in accordance with his wishes. 
" A young lady, desirous of escaping her piano practice, 
complains of pain in one arm and shoulder, and gains the 
sympathy of her unthinking mother, while the same day 
she may devote one or two hours to lawn tennis, or use 
her hands in other ways, and give no report of pain." 
(Hamilton.) Beck refers to the case of a girl of fifteen 
years who, in order to be taken away from school, com- 
plained of severe neuralgia of the face. On a subsequent 
occasion, when a recurrence of the pain was complained of 
for some similar motive, Thompson very successfully em- 
ployed a strong mental remedy, based upon the known 
antipathy she had to a dog. He informed her that the only 
remedy remaining was to rub the affected part over the 
back of that animal. The result was a complete and imme- 
diate cure, without the application of the remedy. 

But, admitting the frequency of malingering in the case 
of pain, the examiner should, on the other hand, avoid the 
risk of making a too hasty diagnosis, since there may be 
cases of real occult disease accompanied by pain, and 
where the latter symptom may be wrongfully attributed to 
imposture. 



184 MEDICAL JURISPRUDENCE. 

Fever, especially of the intermittent and ephemeral types, 
may sometimes be cleverly imitated. The heat of skin and 
excitement of pulse have been produced by the use of stim- 
ulants, as spirits, cantharides, etc., and by friction on the 
skin; the coating of the tongue, by the use of chalk, pipe 
clay, liquorice, etc. Dr. Cheyne was sent for to a soldier 
who was said to be in the chill of an intermittent. He found 
him shaking violently, but, on throwing off the bed-clothes, 
he was seen, not in the cold, but in the sweating stage, pro- 
duced by his exertions. 

Pretended Heart-disease. — Extreme feebleness of the 
pulse has been produced by ligatures around the arm, by 
pressure upon the axillary artery, and, in certain individu- 
als, by taking a deep inspiration and suspending the breath- 
ing. The case of Col. Townshend, reported by Cheyne, 
was of a similar character, where there was a voluntary sus- 
pension of the heart's action for a limited period. Palpita- 
tion may be excited by the internal use of various drugs, as 
tobacco, digitalis, and American hellebore ; also by introduc- 
ing these substances into the rectum. The stethoscope 
should be used in all suspected cases. 

Feigned Pulmonary Tuberculosis. — This disease has been 
simulated by coughing and by producing emaciation by 
abstinence and the use of vinegar ; by pricking the gums or 
fauces and spitting up blood ; by mixing the sputa of 
ordinary catarrh with pus and blood, etc. A careful stetho- 
scopic examination will usually detect the imposture; but 
the examination of the sputa for the specific bacillus will be 
the most satisfactory test. Foreign blood may also be dis- 
covered by the microscope. Hematemesis has been imitated 
by the patient swallowing blood and then throwing it up 
in the presence of spectators. Casper mentions a case of a 



FEIGNED DISEASES. 1 85 

woman who exhibited a bloody handkerchief as an evidence 
of her having vomited blood, but which, on microscopic 
examination, proved to be the blood of a bird. Hematuria 
has been feigned by mixing blood with the urine or by 
using substances that have the power of reddening this 
secretion. The suspected patient should always be made 
to urinate in the presence of the examiner, and the urine be 
properly examined for blood. 

Feigned Incontinence of Urine. — This is frequently prac- 
tised by soldiers in order to get into the hospital. A good 
plan to detect the imposture is to give an opiate at night, 
and introduce the catheter during his sleep ; or by taking 
him by surprise during the day, and introducing the instru- 
ment, when it will be found that the urine has not drained off 
drop by drop as it was secreted, but that the bladder pos- 
sesses the power of retention. If the disease is real, the pre- 
puce and glans penis are found to be pale, from its continu- 
ance, and always moist and the clothes exhale a urinous 
odor. 

Feigned Epilepsy. — This disease is very frequently simu- 
lated, probably for the reason of the pity and affright that 
it is apt to inspire ; and also on account of the short dura- 
tion of the paroxysm and the length of the interval during 
which the patient may enjoy his liberty. Impostors affect 
the most violent forms of the disorder, suddenly falling 
down in convenient places, and writhing in great contor- 
tions ; they thus are apt to overdo it. Many cases may be 
unmasked by threats, or by applying a strong faradic cur- 
rent, or the actual cautery. But instances are related where 
the impostor has suffered all manner of injury rather than 
confess, and the noted Clegg, " the dummy clincher," threw 
himself, in one of his pretended paroxysms, from a corridor 
to the floor, a distance of nearly twenty feet. 



I 86 MEDICAL JURISPRUDENCE. 

Sometimes the impostor will produce frothing at the 
mouth by inserting a piece of soap behind the cheek. In 
suspected cases it is, therefore, well to examine the mouth. 
If closely watched, the malingerer may be observed to look 
about him, or to show some interest in the result of his 
actions. In real epilepsy, there is an entire loss of con- 
sciousness, and also of sensation to the severest applica- 
tions. DeHaen relates the case of a beggar in Paris, who 
often fell in the streets. A bed of straw was prepared, 
through compassion;, on which he might be laid, to pre- 
vent injury to himself. When next attacked, he was laid 
on it, and the four corners set on fire. He sprang up and 
fled. 

The best plan is for the examiner to be fully acquainted 
with the phenomena and signs of the genuine disease, so 
as to be able to compare them with the feigned. . In true 
epilepsy the patient falls forward, and as he falls he is very 
pale; during the convulsion, the features are turgid and 
livid ; the veins of the neck swollen ; the pupils dilated and 
insensible to light; the hands clenched, with the thumbs 
closed within the hands. If the hands be forced open, 
they remain relaxed, whereas in the feigned, they imme- 
diately close again. The muscular rigidity is simultaneous 
over the whole body; nor is there any regular period for 
the return of the fits. Thus, a simulated case was detected 
by the surgeon stating in his hearing that the real disease 
always came on in the morning; he swallowed the bait, 
and the subsequent attacks always occurred before noon. 
In the real disease, the sense of smell is entirely abolished. 
Occasionally there may be hemiplegia. The urine, feces, 
and semen may often be discharged during the paroxysm. 
Ecchymoses are sometimes found on the shoulders after a 



FEIGNED DISEASES. I 8/ 

fit ; and bruises and other injuries may sometimes be met 
with, as results of the fall. 

Beck mentions another fact that should be remembered, 
namely, that the real epileptic is desirous of concealing his 
situation, through a sort of false shame, whilst the pre- 
tender talks about the disease, and apparently delights in 
publicity. In the feigned, the glottis is not closed, and 
respiration, though impeded, is not interrupted; nor does 
the face become so swollen or livid as in the real. 

Feigned Paralysis. — This disease is frequently simulated, 
usually in a single limb, but sometimes in both the upper 
or the lower extremities. In such cases it will be found 
that there is usually more or less rigidity; that there is no 
atrophy, as in the real, and that the electric currents will 
produce their usual reactions. The sensation and reflex 
movements, moreover, are not lost. 

One of the most efficient means of detecting the impostor 
is to administer a severe electric shock. Suddenly and 
unexpectedly seizing the paralyzed limb will sometimes dis- 
cover the fraud, by the patient exerting his strength to pre- 
vent the raising of the limb. 

Hutchinson administered to one who pretended to have 
paralysis of his right arm a large dose of laudanum secretly, 
in his tea, and when he was sound asleep he tickled his 
right ear with a feather, when instantly the lame hand was 
raised. In some cases the pretense may be unmasked by 
the use of anesthetics ; and in one of paralysis of the legs 
reported by Marshall, after every attempt to discover the 
fraud had failed, it was finally brought out by rubbing 
cowhage (Dolichos pruriens) on the soles of the feet, at bed- 
time. He walked and groaned all night, and the next 
morning reported himself fit for duty. 



1 88 MEDICAL JURISPRUDENCE. 

Feigned Unconsciousness, Trance, Catalepsy and Som- 
nambulism. — These different nervous conditions may all be 
simulated, where there is sufficient motive; but careful 
watching and study of the cases will usually succeed in 
detecting the imposture. 

One of the most remarkable cases of feigned uncon- 
sciousness is that of Phineas Adams. This man was a 
soldier and was imprisoned for desertion. He remained 
apparently unconscious for over two months, in spite of 
the most powerful applications in the form of revulsives, 
even to the cutting down through the scalp upon the skull. 
As his case was considered hopeless he was discharged, and 
in a couple of days he was seen perfectly restored, and 
assisting his father in thatching a rick. 

Feigned Diseases of the Eye. — Ophthalmia is artificially 
produced by the introduction of irritants intO' the eye. It 
is, however, detected by the rapidity of its progress, arriving 
at its height within a few hours after the application of the 
irritant. In soldiers, sometimes only one eye is affected, 
and almost uniformly the right one — the one with which 
he takes aim. A left-handed man would probably inflict 
the injury on the left eye. 

It is sometimes difficult to detect cases of blindness 
arising from amaurosis. In this disease the pupil is usually 
dilated and fixed, but there are instances in which it retains 
some contractile power. The patient should be carefully 
watched to see whether he avoids obstacles placed in his 
way. If the pupil contracts perfectly, there is no doubt 
about the case being feigned. The dilated, immovable 
pupil may be imitated by the use of belladonna or other 
mydriatics. 

Feigned Deafness may often be detected by making a 



FEIGNED DISEASES. 1 89 

noise at an unexpected moment, such as dropping a piece of 
metal ; he will be very apt to turn his head in the direction 
from whence the noise proceeded. The suspected person 
should be taken unawares, the tone of the examiner's voice 
should be changed; his countenance should be watched 
while something in which he is personally interested is 
being related to him. A deaf person usually converses in 
a low tone of voice. 

Dunlap mentions the case of a soldier who pretended 
deafness so well that firing a pistol at his ear produced no 
eflfect ; but on trying the experiment after he had been put 
to sleep by opium, he started up out of bed. 

Pretended Deaf-mutism is more difficult to maintain than 
pretended deafness. The best plan, in order to detect the 
imposture, is to say something that deeply interests the 
patient, and watch the physiognomy. Notice also if a 
body left fall near the person will, by its vibrations, cause 
him to look around. The application of a strong faradic 
current over the larynx will sometimes succeed in detecting 
the fraud. 

The case of Victor Travanait illustrates the ingenuity 
and perseverance of some of these cases. This young man 
succeeded for four years in eluding the closest scrutiny 
exercised upon him throughout Europe ; he was, however, 
at last discovered by the celebrated Sicard, of Paris. 

Fictitious Tumors and Enlargements. — These are gener- 
ally feigned by impostors for the purpose of exciting sym- 
pathy and material aid. Hydrocephalus in children, and 
local dropsy in both children and adults, are simulated by 
blowing up the cellular tissues under the skin, and by liga- 
tures on various parts of the body. Mahon relates the case 
of a young woman of Strasburg, whose abdomen commenced 



190 MEDICAL JURISPRUDENCE. 

to swell, and continued to do so for thirty-nine years, by 
which means she excited the commiseration and charity of 
all who saw her, and by which she procured a comfortable 
support. At her death in place of the supposed tumor, 
there was found merely an enormous sack or cushion, 
which she had habitually worn over her abdomen. She 
never would consent to a medical examination for obvious 
reasons. 

Pretended or Factitious Wounds, or voluntary mutilations, 
are inflicted for various purposes, as for attracting sym- 
pathy, or cloaking some criminal act that may have been 
committed. Mutilation of the thumb was common among 
the conscripts of ancient Rome, and it is stated to be quite 
a common practice among soldiers, during modern wars, to 
inflict similar injuries upon themselves, either by fire-arms 
or by cutting instruments. 

The case of Whittaker, the colored West Point cadet, 
affords an illustration of self-inflicted wounds, along with an 
affected unconsciousness, for the purpose of carrying out a 
certain scheme. This youth had repeatedly failed in his 
studies ; and upon the eve of his examination, which would 
most probably have resulted in his suspension, he made a 
desperate attempt to excite the sympathy of the community, 
as well as to gain time for study. One morning he was 
found in his sleeping room, apparently unconscious, and 
tied to his bed with strips of muslin. There were several 
slight cuts, one on the ear and another across the toe. He 
continued apparently unconscious of all surroundings for 
some time, when he opened his eyes in a stupid condition. 
His story was that he had been surprised several hours 
before by a band of masked men, who felled him to the 
floor, and who, after wounding and threatening him left the 



FEIGNED WOUNDS. IQI 

room. Numerous circumstances showed that the whole 
thing was an imposture, and on trial he was found guilty, 
but his sentence was modified. 

Another case was that of a bank cashier, who was found 
gagged and tied, and wounded in a superficial manner, 
while at the same time the funds of the bank were missing. 
It was afterward discovered that the wounds were self- 
inflicted, and that other preparations were made for the 
purpose of diverting suspicion from himself. 

In cases of this character, one very suspicious circum- 
stance is that the wounds are always superficial, and not 
of a dangerous character; they are usually mere cuts or 
scratches, not involving any vital parts. Moreover, the 
cuts or stabs made in the garments will often be found not 
to correspond with those made on the body. It sometimes 
happens that slight and trivial injuries received in a railway 
or other collision are magnified purposely, in order to 
obtain larger damages in a suit at law. Again, persons who 
have unsuccessfully attempted to commit suicide are apt, 
from motives of shame or disappointment, to attribute their 
wounds to another. In such cases, the injuries are super- 
ficial, made usually by the right hand and in front, while 
the hands themselves are seldom wounded ; in a real assault 
the hands are very apt to be cut and maimed. 

Feigned Pregnancy and Delivery will be hereafter con- 
sidered. 

II. Feigned Mental Disorders will be discussed under 
the head of Insanity. 



CHAPTER VIII. 
PREGNANCY. 

The occasions in which Pregnancy becomes the subject 
of medico-legal inquiry are the following: (i) A woman 
may declare herself pregnant with an heir to an estate, for 
the purpose of defrauding other heirs-at-law ; (2) for the 
purpose of extorting money from a seducer or paramour ; 
(3) to stay the infliction of capital punishment until after 
delivery; (4) the plea of pregnancy may be set up as an 
excuse for non-attendance at a trial to awaken sympathy, 
etc.; (5) an accusation of pregnancy may be made against 
a single woman, or one living apart from her husband, 
which may result in an action for damages for slander ; (6)- 
accusations of malpractice may be made against a medical 
man for error in diagnosis of pregnancy, or an attempt to 
bring on an abortion. 

On the other hand, pregnancy may be concealed (i) in 
order to procure abortion or infanticide; (2) in order to 
avoid disgrace. 

The Roman law exempted a pregnant female from capital 
punishment until after delivery. The laws of most modern 
countries follow the Roman custom in this matter. By the 
old English law, under the writ of de ventre hvspiciendo, 
" a jury of twelve matrons, or discreet women," was sum- 
moned to ascertain the fact of pregnancy in the civil case, 
and the further fact of the woman's being " quick with 
child," in a criminal accusation. In Scotland, the preg- 
nancy simply must be proved without reference to quicken- 

192 



SIGNS OF PREGNANCY. 1 93 

ing, and without the jury of matrons. At the present day, 
both in England and in our own country, the jury of 
matrons has been very properly superseded by a jury of 
instructed physicians. 

To enable the physician to decide upon the fact of preg- 
nancy, he must necessarily be acquainted with its signs. 
These may be described under the heads of (i) the uncer- 
tain and (2) the certain, or positive, signs. 

I. Unccrtaifi Signs. — These comprise the following : 

(a) Suppression of the Catamenia. — This may be re- 
garded as a probable sign of pregnancy if it occurs in a 
woman who was always regular, and if at the end of three 
months she recovers her usual health without reestablish- 
ment of the function ; since, if the suppression were the re- 
sult of disease, a general and continued loss of health would 
be apt to follow. But there are many exceptions, — as when 
the menses are suppressed, temporarily, by disease ; when 
menstruation continues throughout pregnancy ; when it 
has never occurred in the woman at all, and yet she has 
given birth to several children and continued in good health ; 
and when the catamenia have appeared only during preg- 
nancy, but were absent at other times. 

In cases of concealed pregnancy, the woman may stain 
her linen with blood (and even with borrowed menstrual 
blood) for the purpose of imitating menstruation. This 
deception may generally be detected by close watching, 
and still more accurately by a microscopic examination of 
the suspected stains. Menstrual blood does not coagulate 
so readily as ordinary human blood, on account of the 
vaginal mucus. It also contains epithelium scales, easily 
recognized by the microscope. 

{b) Morning Sickness. — Nausea is very apt to be an early 
18 



194 MEDICAL JURISPRUDENCE. 

accompaniment of pregnancy, sometimes as early as the 
second or third week after conception. It usually ceases 
after quickening, but it may continue throughout the whole 
period as a most distressing symptom. There are many 
cases, however, where it does not occur; and it is also an 
uncertain sign of pregnancy, because nausea accompanies 
many diseases. 

(c) Enlargement of the Abdomen. — In pregnancy, the 
enlargement of the abdomen begins to be obvious after the 
end of the third month, when the uterus rises out of the 
cavity of the pelvis. At about the fifth month, it is midway 
between the pelvis and umbilicus, which latter it reaches 
at the end of the sixth month. During the seventh month, 
it reaches half way between the umbilicus and the ensiform 
cartilage; at the end of the eighth month, it is on a level 
with this cartilage. During the ninth month, it does not 
ascend higher, but the tumor widens somewhat and falls 
slightly forward. 

This sign is subject to many fallacies: the enlargement 
may proceed from ascites, ovarian dropsy, ovarian tumor, 
retained catamenia, flatus of the intestines, impacted feces, 
excess of fat, distention of the bladder, and enlargement of 
spleen and kidney. Great caution is necessary in order to 
make a diagnosis ; mistakes have been made even by expe- 
rienced examiners. Intestinal flatus may be distinguished 
by percussion; the presence of fluid (ascites and ovarian 
dropsy), by palpation; ovarian enlargement, by its history 
and progress. In true pregnancy, after the seventh month, 
the tumor will sensibly contract under the cold hand, and 
the fetal movements may be distinctly felt. The outlines 
of the fetus also can often be felt. A dark line extending 
from the umbilicus to the pubis may also generally be dis- 



SIGNS OF PREGNANCY. 1 95 

tinguished ; but this may date from a previous pregnancy, 
and also may accompany ovarian enlargement. 

The enlargement of the abdomen may lead to unfounded 
suspicions reflecting upon the reputation and happiness of 
the female. In certain puzzling cases, in which the enlarge- 
ment is accompanied by subjective signs on the part of the 
woman, simulating the movements of the child, it may be 
traced to accumulation of flatus in the intestines, accom- 
panied by contraction of the abdominal muscles, constituting 
a phantom tumor ; this condition is best cleared up by 
placing the woman under ether, when the enlargement will 
be found to subside. 

(d) Quickening. — By this term is understood the first 
perception by the mother of the movements of the fetus. 
Its usual time of occurrence is from about the sixteenth to 
the twenty-fourth week — sometimes earlier, sometimes later. 
It may often be absent together, even when a healthy child 
is born. Its cause is ascribed either to the rising of the 
uterus out of the cavity of the pelvis, or to the increased 
activity of the fetus, or to the latter now coming in contact 
with the uterine walls. However produced, it is a very 
deceptive sign of pregnancy, as it is purely a subjective 
symptom, and many nervous women, especially when anx- 
ious to have children, will mistake movements of the intes- 
tines and the contraction of the abdominal muscles for the 
motions of a child. 

(e) Development of the Breasts. — As a general rule, dur- 
ing the progress of pregnancy, the breasts become larger, 
fuller, more knotty, and tender to the touch ; enlarged veins 
course along the surface; the nipples and the surrounding 
follicles become more prominent; the areola widens and 
assumes a darker hue, especially observable in brunettes. 



196 MEDICAL JURISPRUDENCE. 

In fair women, these changes are often not noticeable. Be- 
sides, enlargement of the breasts often occurs in suppression 
of the menses, in uterine fibroids, and in ovarian and uterine 
disorders. An excessive adipose secretion around the 
breasts is liable to be confounded with a true enlargement 
of the mammary gland. 

The increased development of the breasts, being due to 
the secretion of milk, is more observable towards the end 
of the pregnancy, when, frequently, this secretion is mani- 
fested. 

The presence of milk in the mammary gland is no proof 
of pregnancy, since it has frequently been seen in the 
unimpregnated female, and even in young girls. Dr. E. 
Warren, of North Carolina, relates an instance of a woman, 
aged fifty-five years, whose catamenia had ceased, and who 
was in poor health, when she undertook to bring up the 
child of a deceased friend. To keep it quiet at night, she 
was accustomed to put it to the breast. In six months the 
secretion of milk was perfectly established, and she con- 
tinued to nurse it for twelve months, the child becoming 
healthy and strong. Still more remarkable are the cases 
of secretion in the breasts of males. Dunglison relates the 
case of a man aged fifty-five years, who performed the office 
of wet nurse for several years. . 

(/) The violet color of the vagina, due to venous conges- 
tion (Jacquemin's test), commencing about the fourth week. 
This is considered by Montgomery and others, as a very 
certain sign of pregnancy, though its absence is not to be 
accepted as a negative proof. Dr. R. Barnes regards the 
flattening of the upper wall of the vagina as a reliable sign 
of pregnancy in the early months. It is attributed to the 
enlargement of the womb with slight anteversion, throwing 



SIGNS OF PREGNANCY. 1 97 

the OS backward, and rendering the superior wall of the 
vagina tense. 

II. Certain, or Positive, Signs: — 

(a) Bailottement. — This test will determine the presence 
of a fetus (or some floating body) in the liquor amnii, as 
early as the fifth or sixth month of pregnancy. It is prac- 
tised by causing the woman to stand upright, and introduc- 
ing a finger into the vagina up to the mouth of the womb, 
while the other hand is placed over the abdomen, as as to 
steady the uterine tumor. If the tip of the finger is now 
suddenly jerked upward against the os, a sensation will be 
imparted to it as from a body floating upward in a liquid, 
and falling back again to strike the finger. It is stated that 
floating tumors of the uterus, attached to its walls by a 
pellicle, may produce the same sensation to the finger. 

(b) Change in the Body and Cervix of the Uterus. — The 
shortening of the cervix is perceptible to the touch after the 
fifth month; the os uteri is directed more backward, and 
there is a peculiar velvety feel about it. The neck con- 
tinues to shorten until the ninth month, when it becomes 
obliterated, having been absorbed into the body of the 
womb. The feel of the os in the unimpregnated and in the 
pregnant state is different ; in the latter, it is more patulous 
than in the former. 

(c) The Active Motions of the Child. — These can rarely 
be distinguished before the fifth month, after which they 
usually increase in strength, progressively. They are mani- 
fested by placing the cold hand upon the surface of the 
abdomen. These movements should not be confounded with 
intestinal movements caused by the escape of flatus from 
one portion of the bowels into another. Cases often occur 
in which the active motions of the child are scarcely per- 
ceptible. 



198 MEDICAL JURISPRUDENCE. 

(d) Pulsation of the Fetal Heart. — This is an unequivocal 
proof of pregnancy, when it can be positively and repeatedly 
determined. The sound resembles the ticking of a watch ; 
it is a double sound, not synchronous with the mother's 
pulse, and counting from 150 to 120 a minute, according 
as pregnancy advances. It is heard over different parts of 
the abdomen, but preferably between the ilium and the 
umbilicus, on either side. At times it may be inaudible, 
owing to a change in the position of the child. This sound 
may often be heard as early as the fifth month, but it be- 
comes more distinct as pregnancy advances. 

{e) Other Fetal Sounds. — These are the Uterine and Um- 
bilical Souffle. The first is a peculiar blowing or whistling 
sound, audible over most of the abdomen, and believed to 
be due to the passage of the blood through the uterine 
arteries, or the placental vessels. It is synchronous with 
the pulse of the mother. It can be perceived as early as 
the tenth week, but better at a later period, up to the end 
of the seventh month. It is not an important sign of preg- 
nancy, inasmuch as it may be heard in enlargement of the 
uterus from any cause, as by tumors, etc. 

The second or Umbilical sound is attributed to the circu- 
lation through the umbilical vessels. It is more difficult to 
distinguish than the other sound, and is of little diagnostic 
importance. It is a single bellows murmur, synchronous 
with the pulsations of the fetal heart, and is heard over a 
very limited space, and is best distinguished in cases where 
the cord is wound round the body of the child. With all 
the above signs at command, it is safer not to give a posi- 
tive opinion in a case of suspected pregnancy before the 
sixth month. 

The Corpus Luteum. — The value of the corpus luteum 



SIGNS OF PREGNANCY. 1 99 

or the stellated cicatrix, as a diagnostic sign of pregnancy, 
is materially lessened by the well-ascertained fact that a 
similar body is formed in the ovary after each menstrual 
flow, or, more correctly speaking, after each discharge of 
a ripened ovum. The latter is usually termed a false corpus 
luteum, and it differs from the true corpus luteum of preg- 
nancy in certain particulars, such as the shorter duration, 
the less complete development of the stellate structure and 
yellow color, and the absence of a central cavity. This is 
the general rule; and the reason usually assigned for the 
increased growth and development of the corpus luteum 
of pregnancy is the increased nutrition derived by the 
Graafian follicle, through the stimulus of impregnation. 

The value of this '' sign " is still further lessened by 
the fact that a corpus luteum has been found when there 
has been neither pregnancy nor menstruation. Tidy cites 
two illustrations of this last character ; one, that of a 
prostitute who was poisoned by hydrogen cyanid, when 
neither pregnant nor menstruating, and in whom a fully- 
ripe corpus luteum was found after death. The other, a 
woman who died, aged forty-one, from gangrene of a uterine 
fibroid ; the ovary contained a perfectly formed corpus 
luteum, resembling that of pregnancy. In both these cases 
the author very properly ascribes the abnormal development 
to the increased determination of blood to the part; his 
conclusion being, that " there may be pregnancy without 
the presence of a true corpus luteum, and also that bodies 
undistinguishable from true corpora lutea may be found 
where there has been no pregnancy, and in aged women 
long past the period when pregnancy was probable. 

Instances of precocious pregnancy are mentioned by 
various writers, occurring as early as in the eleventh and 



200 MEDICAL JURISPRUDENCE. 

twelfth years, among the women of India and Abyssinia, 
and occasionally even in temperate climates. The earliest 
period of pregnancy that we find recorded is mentioned 
by Tidy, as given by Mr. Lefevre, of a girl who menstru- 
ated at four years, and became pregnant at eight years. 
Another case is recorded in which pregnancy occurred at 
eight years and ten months, and the child at birth weighed 
seven pounds. In another instance, quoted by Wharton, 
and Stille, menstruation commenced in the first year, and 
pregnancy in the ninth. The child at birth weighed seven 
and three quarter pounds. 

Instances of late pregnancy are recorded, often as late as 
fifty years ; and a case of twins at sixty-four years. 

The question whether a woman may become pregnant 
unconsciously must be answered affirmatively. Women are 
not infrequently raped when in an unconscious state through 
narcotism, or the anesthesia produced by ether or chloroform ; 
and pregnancy may result from such an intercourse, as is 
well known, but that a woman should be unconscious both 
of the fact of sexual intercourse, and also continue uncon- 
scious of the resulting pregnancy up to the birth of her 
child, can scarcely be believed, unless she is feeble-minded or 
idiotic. Cases of this character may occur in unmarried 
women, who may protest most earnestly their utter ignor- 
ance of the whole affair, and pretend to ascribe the pangs 
of labor to colic or some other disorder ; and who, when the 
child is shown them, may positively deny all knowledge of its 
origin. 

With married women the case is quite different. With 
them unconscious pregnancy is a very possible occurrence. 
Many instances might be adduced of married women who, 
having had no children for several years, on becoming 



PREGNANCY IN THE DEAD. 201 

actually pregnant, refused to recognize their true condition, 
ascribing their increase of size to dropsy, or some other 
disorder. 

Cases may occur when it may become necessary to ascer- 
tain the fact of pregnancy in the dead, as e. g., to determine 
the identity of a body, and to rescue the reputation of the 
deceased from the charge of unchastity. It should be 
remembered that the unimpregnated uterus resists putre- 
faction longer than any other organ of the body. Casper 
mentions the case of a young woman whose body was 
found, nine months after her disappearance, in a privy, so 
decomposed that the soft parts separated easily from the 
bones, but the uterus which was firm when examined, proved 
to be in the unimpregnated state. This circumstance was of 
the greatest consequence, as it served to rebut the charge 
of seduction and murder against a young man, who had 
been suspected of foul play. 

On the other hand, the discovery of a fetus, (or a mole) 
in the uterus of the deceased is, of course, decisive proof 
of pregnancy ; and even years after interment, provided the 
fetus has reached the period of ossification, traces of its 
bones may be discovered among the bones of the mother. 



CHAPTER IX. 
CRIMINAL ABORTION, OR FETICIDE. 

Criminal Abortion is the unlawful producing the expul- 
sion, and consequent destruction, of the fetus (usually im- 
mature) from the womb of the mother. The term abortion, 
or miscarriage, is understood in medicine to express the 
expulsion of the fetus before the sixth month of gestation, 
or before it is considered viable ; after this period, it is said 
to be a premature labor. In law, however, no such distinc- 
tion is made, the expulsion of the contents of the uterus at 
any period being considered an abortion. 

It is not necessary here to discuss at what period of utero- 
gestation does the fetus become endowed with life. The 
fact that it evinces no palpable signs of life before quicken- 
ing is no proof whatever of the absence of life ; it merely 
shows that the life is extremely feeble in that early stage of 
its being. 

Formerly, the laws of most countries recognized a dis- 
tinction between an abortion produced before and after 
quickening, awarding a much milder punishment to the 
former than to the latter. The most recent laws of the 
United States and Great Britain recognize no such distinc- 
tion in regard to the criminality of the act, in relation to 
the time of commission. But cases of feticide, although 
extremely common, very rarely become the subject of a 
criminal trial, unless they have resulted in the death of the 
woman, in which case it is regarded as murder. 

Before considering the medico-legal bearings of the sub- 
ject, it will be proper to advert to the fact that abortion very 

2Q3 



CRIMINAL ABORTION. 203 

frequently occurs from natural causes. With some women 
a miscarriage results in the early months of every preg- 
nancy, and this in spite of every effort to prevent it. This 
tendency to abort is greatest at the menstrual periods. 
Among the causes of the abortion are certain constitutional 
diseases, as syphilis, small-pox, fevers, albuminuria, exces- 
sive passions, poisons, death of the ovum, or disease of the 
placenta and membranes. The question whether a natural 
tendency to abort would mitigate the criminality of the act 
of producing it, when it resulted in the death of the woman, 
would doubtless receive a negative reply. • 

The two leading medico-legal questions in every case of 
feticide are : Has the fetus in utero been actually destroyed, 
and what are the evidences? Has this been brought about 
by natural (including accidental) causes, or by artificial (or 
criminal) means? 

I. What are the proofs that a fetus has been destroyed? 
These are derived (i) from an inspection of what has been 
expelled from the uterus, and (2) from an examination of 
the reputed mother. 

I. By an inspection of what has been expelled from the 
uterus, we can discriminate between a true fetus and other 
bodies, such as hydatids, moles, polypi, and membranes. 
The age of the fetus may also be fixed with tolerable accu- 
racy. As regards the nature of the other substances, which 
may be expelled from the womb, it may be remarked that 
the true hydatid is exceedingly rare. The hydatidiform, or 
vesicular mole, is of quite frequent occurrence ; it arises 
from a diseased condition of the villi of the chorion; these 
become infiltrated with serum, and hang in masses, like 
bunches of grapes. These growths are unquestionably the 
result of impregnation. 



204 MEDICAL JURISPRUDENCE. 

Moles are also the result of a diseased condition of the 
membranes of placenta. The fleshy mole is composed of 
layers of fibrous matter enclosing a central cavity, in which 
sometimes fragments of the embryo may be seen. It would 
seem to result from hemorrhage into the chorion. In the 
fatty mole there has also been an early death of the fetus, 
with fatty degeneration of the placenta. A withered fetus 
may often be observed, connected with the diseased pla- 
centa. Both these varieties of moles are positive evidences 
of pregnancy. 

Other substances besides the above may be expelled 
from the uterus, which are not the result of impregnation, 
such as false membranes, the product of dysmenorrhea, and 
also polypi. All these, of course, should be subjected to a 
microscopic examination before an opinion is ventured, and 
lest an unwarranted imputation be formed against the char- 
acter of the woman. 

A fact of some medico-legal importance in connection 
with this subject is that natural abortion usually occurs 
about the third or fourth month, and the ovum is nearly 
always expelled entire — i. e., the membranes not ruptured. 
But as criminal abortion is usually produced about the same 
time, by perforating the membranes, of course the fetus 
would, in that case, be expelled first, and the placenta and 
membranes afterward. This latter circumstance might aid 
materially in the diagnosis of the case. 

2. The signs of an abortion deduced from an examina- 
tion of the reputed mother. These signs are by no means 
satisfactory, especially if the abortion has occurred in the 
early months of gestation. The discharges of blood and the 
relaxed condition of the vagina might easily be ascribed to 
menstruation, and the somewhat open state of the os uteri 



CRIMINAL ABORTION. 205 

might merely indicate some disease of that organ. Hence 
a woman may more readily conceal her condition in the 
early, than in the later months of pregnancy ; but in pro- 
portion as it approaches the full term, the signs of the 
abortion become more definite, resembling those of delivery, 
and which will be discussed hereafter. 

When, however, death has followed within three or four 
days after the attempt to procure the abortion, the case may 
usually be made out satisfactorily ; but if the woman sur- 
vives three or four weeks, it will be almost impossible to 
determine it by the autopsy, since all the usual signs will 
have disappeared ; and this is especially true where the 
abortion has occurred in the early stage of pregnancy. 

In a fatal case of criminal abortion, the first duty of a 
physician is to ascertain how far this is to be ascribed to 
the means employed. For this purpose the vagina and 
uterus should be examined for marks of injury by the use 
of instruments. Wounds on the walls of the vagina would 
indicate the use of instruments, most probably by an inex- 
perienced hand ; whilst perforations of the neck of the 
womb, and sometimes of its fundus, indicate the use of 
pointed instruments, very possibly in the hands of a professed 
abortionist. 

In some instances a blunt instrument, such as a cathe- 
ter, is employed ; and in a case that some time since came 
under Dr. Reese's observation, the attempt to perforate the 
membranes seemed to have failed, while the instrument 
employed passed up between the membranes and the uterine 
walls, and tore the placenta, producing internal hemor- 
rhage, and ending fatally. In cases of instrumental violence 
there will frequently be discovered marks of metritis and 
peritonitis. The stomach and bowels should likewise be 



206 MEDICAL JURISPRUDENCE. 

carefully inspected for signs of irritant poisons (abortives), 
such as redness and the remains of the various reputed 
abortives, as powdered cantharides, savin, ergot, etc. ; also 
for the oils of savin, tansy, pennyroyal, etc. ; the latter may 
sometimes be recognized by the odor, or they may be sepa- 
rated by distillation or by ether. 

In all fatal cases of feticide the condition of the uterus 
and its appendages should be examined, so as to form, at 
least, an approximate estimate of the period of the preg- 
nancy. The uterus in the unimpregnated (normal) state 
measures (according to Montgomery) about two and a half 
inches long, one and three quarter inches broad, and one 
inch thick. Its size, of course, gradually increases as preg- 
nancy advances, according to the following average : very 
little change occurs during the first month. During the 
second month it enlarges considerably. At the end of the 
third month its length is five inches, of which one inch is 
for the cervix. At the end of the fourth month it is five 
inches long from the fundus to the beginning of the cervix. 
At the end of five months, its length is six inches. At six 
months, the length is seven inches. At seven months, it is 
eight inches. At eight months, it is nine to nine and a half 
inches. At nine months, it is ten and a half to twelve 
inches in total length. 

If death should occur from hemorrhage, at full term, no 
contraction of the womb will have taken place ; but if the 
woman survive for a few days, there will always be more or 
less contraction of that organ. In two days after delivery 
(at full term), the womb will have contracted down to seven 
inches in length and four in width ; after one week it will 
be about five or six inches long and two wide; after two 
weeks, the length is four or five inches, and the width one 



CRIMINAL ABORTION. 20^ 

and a half inches. At the end of the second month, it will 
have attained its normal size. 

Its shape also changes as well as its size. In the unim- 
pregnated state it is flat, pyriform, and somewhat triangular. 
After impregnation it assumes somewhat of a globular 
shape ; but no change of consequence occurs in the cervix 
until about the fifth month, after which it progressively 
shortens, losing one fourth its length in the sixth month, 
another fourth in the seventh month, still another fourth 
in the eighth month, and at the close of the ninth month, 
or full term, becoming entirely obliterated, so that at this 
period the shape of the uterus is ovoid. 

The thickness of its walls at full term is about that of the 
unimpregnated condition — one third to two thirds of an inch ; 
but in a few hours after delivery, under contraction, its thick- 
ness increases, often to two inches. 

The uterine vessels undergo considerable enlargement in 
pregnancy — especially the veins, which attain such dimen- 
sions as to be denominated sinuses^ at the position where 
the placenta is attached. The ligaments of the uterus like- 
wise share in the general change. The broad ligaments 
become gradually effaced, in consequence of being absorbed 
(so to speak) in the increased development of the uterus. 
The round ligaments increase in thickness. Both become 
extremely vascular. 

The Fallopian tubes increase in size, become less convo- 
luted, and are much more vascular. Usually that one 
through which the ovum has passed is somewhat the larger. 
The ovaries also share in the general increased vascularity. 
That one from which the ovum escaped displays a peculiar 
fullness or prominence at one portion of the organ. If this 
be cut open, a yellowish-looking body will be observed, 
named corpus luteum, which has already been described. 



208 MEDICAL JURISPRUDENCE. 

It should not be forgotten that all the above signs of 
abortion may occur after the expulsion of hydatids and 
moles; also, that a corpus luteum may be found in the 
virgin state. 

Age of Fetus. — It will be proper to describe the develop- 
ment of the fetus, and with its appearance at the different 
stages of its growth, to furnish the data for establish- 
ing its probable uterine age. At the earliest period when 
the human embryo can be discerned (from fourteen to 
eighteen days), it presents the appearance of a flocculent 
mass, of a semi-transparent, gelatinous consistence, about 
two and a half lines in length. 

In the third or fourth week, the length of the embryo is 
from four to six lines ; the weight twenty grains. Its form 
is curved, and already the rudiments of the several organs 
are visible in the shape of dots and protuberances. At the 
end of the eighth week, the length is fifteen to eighteen 
lines ; the weight, two to five drachms. The head forms 
more than two thirds of the body; the features are more 
distinguishable, and the sex may sometimes be made out. 
At the end of the twelfth week (three months), the length is 
two and a half to three inches ; weight, one to two ounces. 
The whole ovum is now about the size of a goose egg. The 
fingers are separated, but the toes not ; the genital organs 
very prominent. At the end of four months, the length is 
five to seven inches ; weight, six to seven ounces. The skin 
rosy, very delicate, and covered with a fine down; hair on 
the head short and silvery. The disproportionate quantity 
of the amniotic liquor disappears, and the fetus nearly fills 
up the cavity of the uterus. At the end of five months, 
the length is from eight to ten inches ; weight eight to ten 



CRIMINAL ABORTION. 2O9 

ounces; nails distinct; the head, liver, heart, and kidneys 
disproportionately large. If abortion occurs now, the mem- 
branes are usually first ruptured and the fetus escapes. 

At the end of the sixth month the length is about twelve 
inches ; weight, about one pound or over. The color of the 
body is of a cinnabar-red ; down and sebaceous matter cover 
the skin ; umbilicus a little above the pubis ; fat in small 
quantities under the skin ; head very soft ; fontanelles widely 
separated ; palms of hands and soles of feet purplish ; 
scrotum empty ; labia project, but do not conceal the clito- 
ris ; the membrana pupillaris still distinct ; nails distinct ; 
meconium in small quantity in the large intestines ; bladder 
hard and pyriform, with a very small cavity. At the end of 
the seventh month, the length is fourteen to fifteen inches ; 
weight, two to four pounds. The skin is of a dirty-red 
color ; hair on the head about half an inch long ; memhrana 
pupillaris disappearing ; eyelids no longer adherent ; nails 
more firm ; convolutions begin to form on the brain ; meco- 
nium is more abundant ; the ears lie close to the side of the 
head. If the child should now be born, the arms and legs 
will be bent in the position they maintained in the womb. 

At the end of the eighth month, the length is fifteen to 
sixteen inches ; weight, three to four pounds. The skin is 
thicker and more natural, and is covered with a fine, soft 
hair ; hair on head is darker ; nails firmer ; breasts often 
projecting; the testes still at the rings, but often one (the 
left) is found in the scrotum; lungs are reddish; liver still 
very large ; memhrana pupillaris absent. At the end of the 
ninth month, the length is eighteen to twenty inches ; weight 
(average) seven pounds ; ossification more complete ; bones 
of cranium touch each other ; fontanelles smaller ; hair on 
head longer and darker ; nails more solid, and prolonged 

19 



2IO MEDICAL JURISPRUDENCE. 

to the ends of the fingers ; convolutions of brain more 
numerous ; lungs redder and more voluminous ; meconium 
nearly fills the whole intestine ; bladder contains urine ; both 
testes descended, and vulva closed. 

In the development of the fetal brain, its form and dis- 
position, as also that of the spinal cord, can be recognized 
as early as the eighth week. In the third month, the tuber- 
cula quadrigemina, optic thalami, and corpora striata are 
seen ; the medulla oblongata can be distinguished about the 
sixth or seventh month. The gray portion is not formed until 
nearly the end of 'the ninth month. The weight of the fetal 
brain, as stated by Wenzels, is — at five months, 720 grains ; 
at eight months, 4,960 grains; at nine months, 6,150 grains. 

The point of insertion of the umbilical cord will aid in 
determining the age of a fetus, when about its full term. 
From numerous observations, the conclusion arrived at is, 
that at full term the cord is inserted a few lines below the 
middle of the body ; earlier than this, the point of insertion 
is at the center. Moreau's observations, at the Maternite 
of Paris, show, that out of five hundred cases at full term, 
in only four was the umbilicus exactly in the center of the 
body ; in all the rest, it was from eight to ten lines below it. 

Beclard and others have pointed out a very certain test 
of the age of the fetus about the full term, viz., the osseous 
deposit in the inferior epiphysis of the femur. If there is no 
visible trace of this, the fetus cannot be over eight months ; 
if it has the size of a hemp seed (half a line), it is in the 
ninth month ; and if from two to three lines in diameter, it 
has arrived at full term ; if more than three lines, the child 
has probably lived after its birth. 

The weight of children born at the full term varies very 
considerably. As already stated, the average weight may 



CRIMINAL ABORTION. 211 

be taken at about seven pounds, — rather less in females; 
but, in many instances, the weight far exceeds this. Dr. 
Owens mentions one that weighed seventeen and three 
quarter pounds, and that measured twenty-four inches in 
length. Dr. Meadows gives one that weighed eighteen 
pounds and two ounces, and measured thirty-two inches. 
Dr. Donellan, of Louisiana, mentions a case of triplets, of 
which one weighed nine and a half pounds, one seven and a 
half pounds, and one seven pounds, the united weight being 
twenty-four pounds. On the other hand, children at full 
term often fall below the average, weighing only from four 
to six pounds. 

II. The second medico-legal question is. Was the abortion 
produced by natural, or by artificial (criminal) means? The 
examination of the reputed mother, especially if death has 
resulted, would generally settle this question satisfactorily 
by the presence or absence of the results of instrumental or 
other interference. It will be proper here to point out the 
various means that are generally resorted to in order to 
effect the purpose. These criminal means may be consid- 
ered under the heads of general and special. And here 
it may be premised that, as an almost universal rule, where 
there is no constitutional predisposition on the part of the 
woman to abort, this process can very rarely be effected 
except by instrumental interference. Hence, the violent 
measures which are sometimes resorted to to accomplish it. 
Many cases are reported where severe bodily injuries have 
been inflicted with a view to bring on an abortion, but with- 
out the desired result. The most violent exercise, and the 
most brutal violence have been submitted to without success. 

I. The general means include repeated blood-letting, 



212 MEDICAL JURISPRUDENCE. 

emetics, and drastic purgatives. Blood-letting often acts 
as the most effectual means of preventing abortion in 
plethoric women; nevertheless, if it could be shown in a 
case of abortion that the female had previously resorted to 
frequent bleedings, this fact might be received as presump- 
tive evidence against her. The same is true of the employ- 
ment of leeches. 

The above remarks are also applicable to the use of 
emetics. Although violent vomiting might bring on prema- 
ture labor in the last stages of pregnancy in feeble women, 
it can have no effect in the earlier months. The well-known 
nausea and vomiting (the latter sometimes quite violent) of 
pregnancy do not produce miscarriage. 

The drastic cathartics are often resorted to for the same 
purpose ; they may possibly effect it in weak women ; 
especially if predisposed to miscarriage, but as a general 
rule they are powerless. 

2. The special means employed comprise the use of certain 
drugs which are supposed to possess the power to excite 
uterine contraction, and are therefore named emmenagogues 
and abortives ; and also the use of instrumental measures for 
the purpose of puncturing the membranes, and so inducing 
uterine contraction. The number of the popvilar abortives 
is very considerable ; only a few need be noticed here. 

Ergot, or Spurred Rye, undoubtedly possesses ecbolic 
properties ; that is, it is capable of causing contractions of 
the uterus during labor, but it is not certain that it can 
affect this organ in the earlier stages of pregnancy. It is, 
however, certain that it very often fails to bring on miscar- 
riage, although large and repeated doses have been taken. 

Cotton root {Gossypium herbaceiim) has a wide reputation 
as an abortive. It is even said to be more certain and 
powerful than ergot. 



CRIMINAL ABORTION. 21 3 

Savi'ji (tops of Juni penis sahina) is highly esteemed as an 
ecboHc. Its virtues depend on a volatile oil (oil of savin), 
which is also much employed as a popular abortive. Savin 
is a powerful irritant to the stomach and bowels. The oil 
has frequently caused death through peritonitis and gastritis 
without discharging the fetus. It is an exceedingly dan- 
gerous remedy. Tansy, pennyroyal and rue all act in a 
similar manner ; they each contain a powerful volatile oil, 
which is considerably used as an abortive, but in the 
majority of cases without the result intended. They fre- 
quently produce the death of the woman through their 
violent irritant action. Various other substances are em- 
ployed as abortives, such as cantharides, copper sulphate, 
cimicifuga, and potassium iodid, etc. Of one and all of the 
above reputed abortives it may be affirmed, without contra- 
diction, that they are uncertain in their operation on the 
uterus, that they always endanger the mother's life, and that 
they not infrequently destroy the mother, without effecting 
the discharge of the fetus. 

The special means also comprise blows and violent pres- 
sure made upon the abdomen, loins, and back of the woman. 
Occasionally, but by no means always, such procedures may 
result in the expulsion of the fetus, but they necessarily 
entail great risk of life to both mother and child. The use 
of pointed instruments introduced into the uterus so as to 
rupture the membranes is the only certain method of pro- 
ducing uterine contraction and insuring the expulsion of 
its contents. This operation in the hands of empirics, or of 
the female herself, is often followed by very serious and 
fatal consequences, from wounding and even perforating the 
womb. Other methods are sometimes successfully em- 
ployed, as the injection of warm water between the uterus 



214 MEDICAL JURISPRUDENCE. 

and ovum, and the dilatation of the os uteri by means of 
sponge and other tents, or by the use of Barnes' dilator. 
A case is mentioned by Dr. Channing, in which a bent wire 
was introduced into the uterus, where it became entangled 
in the tissue and had to be cut off; the piece remained 
within for six years, and, singular to remark, the case was 
one of merely suspected pregnancy. In another case, strong 
sulphuric acid was injected into the vagina for the purpose 
of bringing on an abortion. The result was violent inflam- 
mation, causing adhesion of the walls of the vagina, and 
also of the bladder. The Csesarean section was finally per- 
formed, which terminated fatally. 

Druggists are often asked for substances to produce 
abortion, and in order not to offend by refusing to sell, 
yet not involve themselves in a criminal act, dispense 
harmless powder, such as milk-sugar or starch mixed with 
a small amount of quinin to give a marked taste, and thus 
lead the person to believe that an active drug is being used. 

Before leaving this subject, it is proper to state that the 
operation for abortion may sometimes become necessary 
in regular medical practice. The cases demanding it are 
deformity of the pelvis to such an extent as to preclude the 
possibility of delivery of a living child at full term ; and 
possibly when the vomiting during pregnancy is of such a 
violent and continued character as actually to endanger the 
mother's life. In every such case, however, the practitioner 
should secure a consultation before venturing to perform 
the operation. 

Abortion may sometimes be feigned for sinister purposes, 
such as to secure compensation for an alleged seduction and 
consequent pregnancy, or to excite sympathy and aid. In 



CRIMINAL ABORTION. 215 

such cases, a thorough examination of the woman and the 
alleged fetus will serve to clear the matter up. 

Legally considered, the criminality of abortion is not 
affected by the fact that the woman was not really pregnant, 
nor by the birth of monstrosities or of moles, nor by the 
fact of an extra-uterine pregnancy. 



CHAPTER X. 
INFANTICIDE. 

By Infanticide is understood the criminal destruction of 
the new-born child. In a legal sense, it is immaterial 
whether the child is killed immediately after its birth, or a 
few days subsequently. 

The crime of Infanticide has been prevalent throughout 
the world, from the remotest period of history. Before the 
establishment of Christianity it was allowed among the 
most enlightened and cultivated nations of the earth, and 
even at the present day its practice is frequent in the most 
civilized countries, although placed under the ban of the 
law, and involving mostly the destruction of illegitimate 
children. Child-murder is treated by the law like any other 
form of homicide, and tried by the usual rules of evidence 
in such cases. There is this important point in the nature 
of the medical evidence required, namely, that it must prove 
satisfactorily that the child was born alive ; in other words 
the burden of proof that a living child was destroyed is 
thrown upon the prosecution. The law humanely assumes 
that a dead child has been born dead, until the con- 
trary is shown, because so many children do thus actually 
come into the world, and many others die very soon after, 
from various causes ; and in these latter, the signs of their 
having lived are frequently indistinct. As the charge of 
infanticide can never be sustained unless there is distinct 
proof that the child was legally alive at its birth, great diffi- 
culty is usually experienced in obtaining sufficient evidence 
to convict a woman accused of this crime. As a general rule, 

216 



INFANTICIDE. 21/ 

she has been delivered in secret, with no witness of the birth ; 
and the body of the child is frequently concealed or de- 
stroyed. There is, besides, a general reluctance on the part 
of a jury to convict a woman of willful murder for this 
crime, horrible as it is, on account of a feeling of sympathy 
for the prisoner arising from the probability of her seduc- 
tion and desertion. 

The term " born alive," in the legal sense, implies the 
complete expulsion of a living child from the mother. A 
child is not " born " legally, if any portion of its body — a 
leg, for instance — is retained within the vulva. Hence, 
through a fiction of the law, the destruction of a living 
child, if only partially born, is not regarded as murder ! It 
is not, however, necessary that the umbilical cord should 
be cut, in order to come within the meaning of the statute. 

In the majority of cases of infanticide, the child has ar- 
rived at the full term of gestation ; but, as children are often 
born at an earlier period, — either naturally, or by artificial 
means, — the examiner should be prepared, from the inspec- 
tion of the body, to give an opinion as to the probable age 
that the child had attained in the uterus. For this purpose, 
he should be acquainted with the general appearance, size, 
and development of the fetus at the diflferent periods of its 
uterine life. 

In case of infanticide, the medico-legal questions in- 
volved pertain, first, to the infant, and, secondly, to the 
reputed mother. 

I. Questions relating to the infant : ( i ) Was it horn alive f 
(2) What was the cause of its death? (3) Its age? (4) 
The interval since its death? 

I. Was it horn alive? In the absence of all positive evi- 
dence from witnesses, the inference must be derived from 
20 



2l8 MEDICAL JURISPRUDENCE. 

the external appearance, and from the internal examination 
of the child's body. The general appearance of the body of 
an infant that was born alive, at full term, and had breathed, 
may be described as follows : The remains of the sebaceous 
matter {vernix case o so) will usually be found under the 
arm-pits and behind the ears ; the hair will be dry and clean ; 
the ears do not lie so close to the side of the head as in 
dead-born children; the eyes remain half open, in spite of 
all efforts to close them ; the caput succedaneum, or swell- 
ing on the back of the head, is much more distinct than in 
the still-born child ; the former contains a glutinous, bloody 
serum, while in the latter there is only a small quantity of 
colorless liquid. The thorax is more arched, and the dia- 
phragm more depressed, than in the case of the still-born. 
According to Casper, the highest level of the diaphragm in 
the still-born child is between the fourth and fifth ribs, while 
it descends to between the sixth and seventh in the living. 
The lungs will also present unmistakable evidences, which 
will be described later. The remnant of the umbilical cord 
attached to the body -will exhibit evidence of commencing 
desiccation, if the child has lived for a few hours. 

A dead-born child, having perished immediately before 
its birth, will usually be found more or less covered with 
the vernix caseosa; its hair closely agglutinated; ears lie 
close to the side of the head ; eyes closed, and eyelids, 
when raised, do not remain open ; mouth closed, and a 
drop of watery blood is often seen trickling from the nostril. 
The thorax appears flat and unexpanded; the trachea is 
flattened, and often contains a viscid, mucous secretion. 
The lungs lie in the posterior part of the thorax; they are 
of a brownish-red color, have a granular structure, and do 
not crepitate upon pressure; their length is greater than 



INFANTICIDE. 2I9 

their breadth, and their edges are rounded. The remnant 
of the iimbiHcal cord has a fresher look than when the child 
has lived a few hours 

If the death of the fetus has occurred some time before 
its birth, there will be the following signs of intra-uterine 
putrefaction: The body is extremely flaccid and flattened, 
as if it had been macerated in water ; the skin is spotted, 
and the cuticle detached in many places, especially on the 
abdomen ; the head lies perfectly flat in any position ; the 
bones of the cranium move easily on one another ; the face 
is flattened and the features distorted. The cellular tissue 
and cavities are infiltrated with a bloody serum ; the viscera 
are easily loosened from one another; gas is developed in 
the lungs and liver. The color of the lungs is dark brown. 
There is an absence of the usual odor, and also of the green 
color of ordinary putrefaction. 

It is important to have clear and definite ideas concern- 
ing the proofs of a live birth, in cases of infanticide. It is 
well known that many children come into the world still- 
born — that is, without giving any sign of life by respiration 
or otherwise — and yet, by proper attention, they subse- 
quently revive and continue to live. From this it is to be 
inferred that respiration is not the only evidence of a live 
birth. Nevertheless, in the cases of infanticide that come 
under judicial investigation, in which the proofs of a living 
birth are to be discovered solely by an inspection of the 
dead body of the child, the fact of respiration is the main 
point to be determined by the examiner. If this fact can 
be satisfactorily proved, there can be no doubt that the 
child had lived ; but it does not necessarily prove that it 
was born alive, since it might have perished (naturally or 
otherwise) before it was actually born, in the legal sense. 



220 MEDICAL JURISPRUDENCE. 

Again, a child may live for several hours after its birth, 
breathing very feebly; and after its death the air cells of 
the lungs may present no evidence of distention; so that, 
judged by this single sign presented after death, the child 
would be said to have been born dead. 

As to the question whether any evidence of life before 
respiration can be discovered in the dead body in a case of 
infanticide, the answer must be that, at present, there are no 
satisfactory medical data to enable one to express a positive 
opinion in such cases — certainly not from a mere inspection 
of the lungs. Should there, however, be other evidence, 
such as marks of great violence upon the body, or proofs, 
through witnesses, that respiration had been designedly pre- 
vented, either by the woman herself or by an accomplice, 
such circumstances would certainly afford very strong pre- 
sumption of murder. Dr. Causse, quoted by Taylor, con- 
tends that a true ecchymosis found on the body of a new- 
born child is proof that the blood was circulating at the 
time, and that it had been extravasated, which could only 
occur in a living body; and that this proof would be 
strengthened if the blood was found coagulated, and the 
surrounding tissues deeply infiltrated. Devergie held a 
similar opinion in relation to the significance of ecchymoses 
and infiltration of blood. Still, while fully admitting the 
force of these proofs of vitality as good medical evidence, 
they are scarcely to be received as sufficient of themselves 
to establish the charge, since they are open to the objection 
that the injuries might have been inflicted during birth, or 
accidentally after birth. 

Proofs that the Child has Breathed. — These proofs are 
derived (i) from the organs of respiration; (2) from the 
organs of circulation ; (3) from the abdominal organs. 



INFANTICIDE. 221 

I. Proofs afforded by the respiratory organs. 

(a) The thorax is higher or more vaulted in appearance 
than when the child has not breathed; its capacity is in- 
creased ; but the attempt to indicate these changes by actual 
measurements and comparisons cannot be depended upon, on 
account of the natural difference in the size of the thorax 
in different children at birth. 

(b) The diaphragm is considerably more depressed after 
respiration has been established than before ; according to 
Casper (as already mentioned), in children born dead its 
highest point reaches between the fourth and fifth ribs, 
whereas in those born alive and fully respiring it descends 
to between the sixth and seventh ribs ; the position of the 
diaphragm may also be affected by the gases produced 
during putrefaction. 

(c) The larynx, before breathing, is narrower, contains 
more or less mucus, and is closely approximated to the 
epiglottis ; after respiration it is wider, and is not closed by 
the epiglottis. 

(d) The Situation and Volume of the Lungs. — Before 
breathing, these organs are placed far back in the thorax, 
so as almost to escape notice. After complete respiration 
they project forward so as completely to fill the cavity of 
the chest, and cover, and to a great extent conceal, the heart 
and pericardium. If respiration has been imperfect, the 
volume of the lungs is proportionately less developed. 

(e) The Consistence of the Lungs. — Before respiration 
they have a firm and compact feel, and they are of the con- 
sistency of liver ; after full breathing they are spongy and 
crepitant to the touch. When cut, there is an escape of 
blood-froth ; and when pressed between the fingers under 
water, air-bubbles will ris^ to the surface. A thin section, 



222 MEDICAL JURISPRUDENCE. 

when examined by the microscope, will show distinct air 
cells. It must, however, be remembered that the lungs of 
infants that have lived a considerable time after birth, but 
that have breathed very imperfectly, will sometimes not 
crepitate under the finger, nor will they float on water. 

(/) Their Color. — Before respiration, this is bluish-red or 
violet, resembling that of the spleen. A short exposure to 
the air will render the color brighter. After full respiration 
their color changes to a pale red, becoming bright scarlet 
after free exposure to the air, or else irregular bright spots 
appear upon a bluish-red ground, giving them a marbled 
appearance, a peculiarity which cannot be given to fetal 
lungs by artificial inflation. " This insular marbling of the 
lungs is characteristic of lungs that have breathed, and is 
due to the presence of blood in the vessels surrounding the 
inflated lung tissue" (Husband). In imperfect respiration, 
and as a result of disease, the color of the lungs may be 
much modified. 

(g) Their Absolute Weight, or the Static Test. — The 
weight of the lungs before respiration is less than after fhat 
process has been established, owing to the presence of blood 
circulating in them. The average weight before respiration, 
derived from nine cases, according to Taylor, was 649 
grains. Dr. Traill gives it as varying from 430 to 600 
grains. The average weight after respiration, in three cases, 
was 927 grains. From these data attempts have been made 
to institute comparisons in unknown cases ; but so much 
depends upon the maturity or immaturity of the child and 
the degree of respiration, that the test is unworthy of confi- 
dence. Great weight of the lungs cannot, of itself, furnish 
proof of respiration, unless accompanied by increase of vol- 
ume from the presence of air, and by crepitation and the 



INFANTICIDE. 223 

distention of the air cells ; it may really be due to disease. 
Dr. Taylor relates a case where the lungs weighed upward 
of 1,200 grains; they contained no air, and when cut into 
thirty pieces not one floated on water. 

Specific Graz'ity of the Lungs. — This is greater before 
than after respiration ; because the air received throughout 
the air cells in breathing more than counterbalances the addi- 
tional weight derived from the blood circulating through 
them. Dr. Taylor found, as the result of several experi- 
ments, that the specific gravity of the lungs in the fetal 
state varied from 1.04 to 1.05 ; after respiration it was 0.94 
(one experiment). It will, of course, be understood that the 
specific gravity of the substance of the lungs remains 
unchanged; it is only rendered apparently lighter by the 
introduction of air into the cells. The introduction of a 
very small quantity of air is sufficient to render the fetal 
lungs buoyant in water ; and it matters not whether this air 
is derived from respiration, artificial inflation, or putrefac- 
tion. It is on this property of the lungs that the application 
of what is termed the hydrostatic test is founded. 

The Hydrostatic Test — Docimasia Pulmonum. — The prin- 
ciples involved in this test have just been noticed — the fact 
that the lungs in their fetal or unaerated condition sink 
when put into water, while the lungs of a child that has 
breathed, or where they have been otherwise inflated, float 
in water. 

The mode of applying this test is very simple. Having 
carefully removed the lungs from the chest (usually along 
with the heart and thymus gland), these should be put into 
a sufficiently capacious vessel containing distilled, or river 
water, at 60° F. If they are very buoyant, much of them 
floating on the surface of the water, this indicates very 



224 MEDICAL JURISPRUDENCE. 

complete aeration of the lungs, and may be regarded as a 
strong proof of respiration at birth. If they are less buoy- 
ant, floating largely under the surface, the indication is that 
the aeration was not complete. Each lung should now be 
tried separately, to determine if each is equally buoyant. 
Then each one should be divided into about fifteen pieces, 
and each fragment separately tested. If all the pieces float, 
even after firm compression, the inference would be that 
respiration had been very perfectly performed. If they sink, 
it should be noticed whether this occurs rapidly or slowly. 
The lungs should then be tested separately — one may sink, 
while the other (commonly the right) may float. Supposing 
both to sink, they should each be divided into pieces, and 
each one tried separately, as before described. If all the 
pieces sink, the inference is that, although the child may 
have survived its birth for a short time, there is no evidence 
of its having breathed. 

Much useless discussion has occurred as to the true value 
of the hydrostatic test in a case of infanticide. It must be 
evident, on a careful consideration of the principles involved 
in this test, that it can only prove the aeration or the non- 
aeration of the child's lungs ; it does not necessarily prove 
respiration, although it establishes a very strong probability 
of it. Moreover, as respiration may take place — partially, 
at least, as in certain cases of face presentation, where the 
labor has been protracted and the vagina widely dilated — 
while the head was yet in the uterus or in the vagina, and 
frequently after the head has been born, but before the 
complete extraction of the body, it follows that the hydro- 
static test can never prove a live birth, but merely that the 
child had breathed, and therefore was alive at or about the 
time of its birth. 



INFANTICIDE. 22$ 

Two objections have been offered against the hydrostatic 
test which deserve notice. 

I. That the Imigs may iioat although the child may not 
have breathed — (a) from artificial inflation ; (b) from putre- 
faction ; (c) from emphysema. 

(a) ArtiUcial Inflation. — In reply to this objection it may 
be stated that it is extremely difficult to distend the whole 
lung artificially through the mouth, even if a tube and bel- 
lows be employed; most of the air will be found to have 
passed into the stomach. Besides, the force of the objec- 
tion seems to be met by the fact that, in a case of child mur- 
der, the great object of the woman and her accomplices is 
to make it appear that the child was born dead ; they would, 
therefore, hardly be likely to adopt measures that would sug- 
gest a strong probability of a live birth. 

It must, however, be admitted that, while artificial infla- 
tion of the lungs can never be mistaken for perfect respira- 
tion, it might be confounded with imperfect breathing. In 
both cases, the lungs will be more or less buoyant ; they 
will crepitate under pressure; when divided into fragments 
many of these will float on water ; and in some exceptional 
cases, firm pressure made on pieces of a lung artificially 
inflated through a tube has failed to cause these pieces to 
sink. As a general rule, strong compression on a fragment 
of lung artificially inflated by the mouth will so completely 
remove the air as to cause it to sink in water; whilst no 
amount of force, short of an entire disintegration of tissue, 
will prevent the floating in cases where natural respiration 
has been fully performed. 

There are other points, however, to be noticed in making 
the diagnosis, viz., that artificial inflation does not increase 
the actual weight of the lungs, like respiration, because it 



226 MEDICAL JURISPRUDENCE. 

does not invite the blood into them ; and also that the color 
of the artificially-inflated lung is a uniform cinnabar-red, 
without any marbling. The explanation of this will be 
obvious on reflection. Natural respiration tends to create 
a vacuum in the lungs, and consequently to draw into them 
the blood of the pulmonary arteries, which gives them the 
comparatively dark-bluish and marbled appearance alluded 
to; but artificial respiration, by which air is forced into the 
lungs, tends by the pressure of that air, to exclude the 
blood, and consequently to render the color of the lungs 
still lighter than before. A fragment of the lung squeezed 
under water will exude air, but no blood (Lutaud) . Casper's 
opinion about the matter is : " When we observe a sound of 
crepitation, without any escape of blood-froth on incision, 
laceration of the pulmonary air cells with hyperemia, bright 
cinnabar-red color of the lungs without any marbling, and 
perhaps air in the artificially inflated stomach and intestines, 
we may, with certainty, conclude that the lungs have been 
artificially inflated." 

(b) Putrefaction. — It is admitted that the lungs of a dead- 
born child will float, as the result of the gases generated by 
putrefaction. The air thus evolved is not contained in the 
air cells of the lungs, but in the cellular tissue, and chiefly 
between the lobes and lobules. Moreover it collects in 
rows or bubbles, which are much larger than the air vesicles, 
prominent and disappearing entirely under sHght pressure. 
At the same time, the lungs themselves present other evi- 
dences of putrefaction, such as a greenish color, a fetid 
odor, and diminished consistence. If a portion be cut out 
from the interior of the lung it will be found to sink in 
water. Again, if the air be squeezed out of a portion of 
the lung it will no longer float in water. There is also a 
want of crepitation in a putrescent lung. 



INFANTICIDE. 2 2/ 

The exact period when the fetal hmgs undergo putre- 
faction cannot be fixed ; but it is known that it is delayed 
much longer than in the other organs of the child ; con- 
sequently, in a doubtful case, if the other organs give no 
evidence of decomposition we may be certain that the 
buoyancy of the lungs is not owing to putrefaction. After 
complete decomposition the lungs again sink in water. 
There ought to be no difficulty in distinguishing between 
the buoyancy of respiration and that resulting from putre- 
faction, in employing the hydrostatic test. 

(c) Emphysema. — This was formerly regarded as a dis- 
eased (congenital) condition of the lungs, which caused 
them to float in water in the absence of respiration ; but its 
existence is considered as questionable. Casper's decided 
opinion is that, *' as yet not one single well-observed and 
incontestable case of emphysema developing itself spon- 
taneously within the fetal lungs is known ; and it is, there- 
fore not permissible in forensic medicine to ascribe the 
buoyancy of the lungs of new-born children to this cause." 

11. That the lungs may sink in water, although the child 
may have breathed and lived. 

(a) From disease, as pneumonia, congestion and atelec- 
tasis pulmonum. These would increase the density of the 
pulmonary tissue, and cause it to sink in water. But the 
first two conditions are extremely rare in the new-born 
child, and the latter is to be regarded as simply the original 
fetal, undeveloped condition of the lung (Casper, Meigs). 
If ever found they can be readily recognized by their general 
appearances, and also by dividing the lungs into pieces and 
finding that some of the fragments will float. In the case 
of congestion, if a piece of the lung be squeezed so as to 
remove the blood, it will be found to float. 



228 MEDICAL JURISPRUDENCE. 

(b) In those cases in which the child has survived for 
some time, but the respiration is so feeble as not to inflate 
the lungs, the hydrostatic test will generally, though by no 
means always, discover the presence of air in a few of the 
pieces of the lungs, when these have been divided. In case 
every fragment sinks this test can, of course, render no 
assistance, a circumstance which is certain, to be regretted, 
inasmuch as it does not permit us always to ascertain the 
truth. 

The general deductions from the two foregoing objec- 
tions are the following: 

1. The lungs float (i) from natural respiration; (2) from 
artificial inflation; (3) from putrefaction; (4) from emphy- 
sema (possibly). Therefore the mere buoyancy of the 
lungs is not, of itself, positive proof of respiration ; but, with 
proper precautions, the test may be depended upon. 

2. The lungs sink ( i ) from total want of respiration ; 
(2) from feeble or imperfect respiration; (3) from disease. 
Hence, the mere sinking of the lungs in water is not of 
itself a positive evidence that the child has not breathed ; 
but with due precautions it may be regarded as a safe test. 

As the hydrostatic test is of such importance in cases 
of infanticide, great carefulness should be observed in its 
employment. The chest should be properly opened, and 
the position, size, color, etc., of the lungs accurately noted. 
The great vessels are then to be tied and cut at their roots. 
The trachea is to be divided as close as possible to the 
lungs; these are next to be taken out, together with the 
heart and thymus gland, and closely examined for disease 
or putrefaction, also for crepitation on pressure. A suitable 
vessel, containing fresh water at 60° F., should be provided. 
It is important to attend to the temperature of the water. 



INFANTICIDE. 229 

since its buoyant power varies considerably between 40° F. 
and 212°. For the sake of uniformity the mean tempera- 
ture of 60° should always be employed. For a similar 
reason fresh and not salt water ought to be used. The lungs, 
together with the trachea and bronchi, are then to be placed 
in the water, and it should be noticed whether, and how, 
they float or sink. The lungs should then be separated 
from the heart and from each other, and accurately weighed. 
They should again be placed separately in the water and 
the result noticed. If one only floats, note which one it is. 
Each lung should then be cut up into about fifteen pieces, 
and each piece submitted to the test. They should next be 
subjected to suitable compression, by enclosing them within 
the folds of a towel and pressure applied ; after which they 
should again be put into the water, and the result noted as 
to whether they continue to float or not. 

There are a number of striking peculiarities in the circu- 
latory organs of the fetus, which are modified or entirely 
lost after respiration is established. A knowledge of these 
changes is therefore of importance in a case of infanticide. 
The evidence to be derived from the changes in the heart 
and fetal vessels comprises the examination of the foramen 
ovale, the ductus arteriosus, the ductus venosus, and the um- 
bilical cord. Although as a general rule the closure of the 
three first-named openings takes place at birth or soon after, 
yet in many instances it occupies a considerable time, so 
that in cases of infanticide the test is, practically, of little or 
no value. 

The foramen ovale is the opening between the two 
auricles of the fetal heart, through which, before respira- 
tion, the blood passes directly from the right to the left side 



230 MEDICAL JURISPRUDENCE. 

of that organ. It usually closes at birth, or very soon after, 
but instances are known where it continues open up .to 
adult years, and even throughout life. 

The ductus arteriosus is a vessel about half an inch long, 
which in the fetus forms a direct communication from the 
right ventricle to the aorta ; it may, in fact, be regarded as 
a direct continuation of the pulmonary artery to the aorta. 

The effect of this arrangement is that most of the blood 
from the right side of the heart, instead of being propelled 
to the lungs through the right and left branches of the pul- 
monary artery, is sent directly to the aorta, and thence into 
the general circulation. The branches of the pulmonary 
artery, in the fetal state, are small, inasmuch as they trans- 
mit but little blood. 

As soon as respiration commences, the ductus arteriosus 
begins to contract — at first at its aortic extremity, and grad- 
ually throughout its caliber, until, finally, the whole vessel 
dwindles down to an impervious cord. During this same 
period the branches of the pulmonary artery increase in size, 
in order to transmit the due supply of blood to the lungs, 
which are now performing their proper function. The 
closure of the duct, although usually a proof of a living 
birth, is by no means uniformly so ; neither is its open con- 
dition a positive evidence of a dead birth, since its closure 
is gradual and frequently protracted. 

The ductus venosus arises from the umbilical vein, and 
opens into the ascending vena ca^va. It is found in the 
posterior part of the longitudinal fissure of the liver. Its 
closure is apt to occur rather sooner than the other open- 
ings before alluded to ; but it is quite uncertain as a sign of 
a live birth. 

The umbilical vessels consist of a vein and two arteries. 



INFANTICIDE. 23 1 

The former conveys the blood aerated in the placenta to the 
fetus, passing in at the umbilicus ; and proceeding onward 
it divides, one part going into the liver and the other part 
going through the ductus venosiis into the ascending veym 
cava, and so carrying purified blood to the right auricle of 
the heart. The two umbilical arteries are continuations of 
the hypogastrics ; they convey the effete blood out of the 
body, through the navel, back again to the placenta, there 
to be renewed. After birth, when the route of the circula- 
tion undergoes such a complete change, these vessels be- 
come closed and obliterated; but the exact time when the 
closure takes place is hardly more certain than in the case 
of the other fetal channels. 

The desiccation of the umbilical cord affords valuable evi- 
dence of a live birth, especially if the child has survived 
several days. The cord is usually of a bluish, pearly-white 
color, about the thickness of a finger ; and within twelve to 
twenty-four hours after birth loses its polish, becoming dry 
and flaccid. It is generally cut and tied about three inches 
from the umbilicus, at the time of the birth. The process 
of desiccation commences at the severed end; in the course 
of twenty-four hours it reaches to within half an inch of the 
navel, this portion still remaining pulpy, and of an amber 
color. About this time the skin of the abdomen around 
the umbilicus becomes red and swollen, and is pushed up 
around it in the shape of an inverted cone. During the 
second and third day the cord gradually withers and dies, 
becoming flattened and twisted, and suppuration begins on 
the still moist portion attached to the navel. A line of 
demarcation is seen forming; and on the fourth day the 
free end of the cord becomes of a yellowish-brown or black 
color, and has the appearance of transparent glue. The 



232 MEDICAL JURISPRUDENCE. 

separation of the cord usually occurs on the fourth, fifth, 
and sixth days — the majority of cases being on the fifth. 
Occasionally, the separation takes place some days later. 

The existence of an inflammatory zone about the umbili- 
cus is one of the signs of importance in judging whether an 
infant has lived after birth. In one case Dr. Kirk, of Edin- 
burgh, found such a zone and gave judgment that the child 
had lived. As the result of subsequent investigation of sev- 
eral cases, he came to the conclusion that if a child lives an 
hour after birth there will be a slight circle of inflamed tissue 
about the insertion of the cord; this zone becomes more 
pronounced every hour after birth. 

Although the separation of the cord is a vital act and 
can occur only in a living child, its desiccation may take 
place equally in a dead child, although it occupies a much 
longer time in the latter, sometimes not commencing for 
several days after birth. But the important point of distinc- 
tion between the two is that spontaneous separation of the 
cord never occurs in a dead-born child; it merely withers 
and dries up, but remains attached. Hence, the desiccation 
and separation of the cord and the subsequent cicatrization 
afford positive proof that the child was born alive, and had 
continued to live some days after its birth. 

In the fetus the liver is, relatively, enormously large and 
very vascular, doubtless in consequence of the important 
function it has to perform in connection with the circulation 
of the blood. Meckel found the absolute weight of the 
liver to diminish until the end of the first year of extra- 
uterine life. In five new-born children the liver was found 
to be one fourth heavier than in five other children of eight 
to ten months old. 

The stomach and intestinal canal may sometimes afford 



INFANTICIDE. 233 

positive proofs of a live birth, from the discovery therein of 
certain matters — liquid and solid — such as blood, milk, 
farinaceous and saccharine articles. The two former sub- 
stances may be identified by the microscope, which, how- 
ever, fails to distinguish between human and cow's milk; 
but the detection of colostrum corpuscles in the contents of 
the child's stomach would be good evidence that the milk 
was from a woman very recently delivered. Another test 
for the presence of milk is that of Trommer for milk-sugar. 
The suspected substance, properly diluted, is treated with a 
few drops of a weak solution of copper sulphate, sodium 
hydroxid added in excess, and then boiled ; a red precipi- 
tate indicates the presence of sugar. 

Starchy matters may be easily recognized by the appli- 
cation of tincture of iodin, which imparts a deep blue color ; 
and also by microscopic examination, which may even iden- 
tify the particular variety of starch — as arrowroot, potato 
starch, etc. 

The presence of blood in the stomach is not necessarily 
evidence that the child was born alive, since it is possible 
that it might have been drawn into the throat from the 
maternal discharges, during the passage of the head through 
the outlet, and before it had breathed. 

The presence of meconium in the stomach, like that of 
blood, is not a positive indication of a live birth, because 
the child may have drawn it into the stomach and air pas- 
sages by aspiration, in the passing of the head over this 
substance, through the outlet. Meconium is recognized by 
its dirty, dark-green color and want of fecal odor. The 
microscope shows it to contain crystals of cholesterol, 
epithelial scales, masses of green coloring matter of bile 
and granules. 

21 



234 MEDICAL JURISPRUDENCE. 

The absence of meconium from the intestines (where it 
is usually found at birth), and also the absence of urine 
from the bladder, are not, necessarily, evidences that the 
child has been born alive, since these liquids may be dis- 
charged during the act of birth. 

11. Causes of Death in the New-horn Child. — Having dis- 
posed of the Question I. — Has the child been born alive? — 
we are now prepared to discuss the second, viz. : What was 
the cause of its death? These causes are various. They 
may be considered under the heads of such as act during 
birth, and such as act subsequently; also, such as are acci- 
dental, and such as are criminal. It is the latter only that 
can be connected with a charge of infanticide. 

In an investigation of this character it should be remem- 
bered that many children are still-born, the proportion being 
one in every eighteen or twenty of legitimate children. 
Among illegitimate children the proportion is much greater 
— probably one in ten (Taylor). As before mentioned, this 
throws the burden of proof of a live birth, in a case of in- 
fanticide, on the prosecution, as the law assumes in all such 
cases that the child was born dead. 

I. Causes Acting During Birth. — (i) Compression of, 
and by, the umbilical cord. This may happen in breech or 
foot presentations ; also when the cord is prolapsed in these, 
or in head presentations. In such labors it is well understood 
that unless the cord is speedily relieved of pressure, the 
child will perish. Another cause of compression arises 
from the cord being wound round the child's neck. This is 
quite a frequent complication, according to Elsasser, being 
found as often as one in every five cases. In the latter in- 
stance death may proceed either from the constriction of the 
child's neck, by the cord causing congestion of the brain. 



INFANTICIDE. 235 

or from the interruption of the flow of blood in the cord 
itself, owing to the strain upon it. The effects of the con- 
striction of the neck by the cord are not precisely similar 
to those of strangulation in a child that has breathed; 
and inasmuch as children are not infrequently purposely 
strangled after the head is born, and before the rest of the 
body is expelled, it is important to understand if there are 
any means of distinguishing between the two cases. 

In the last-mentioned case, if the child had not breathed 
when the strangulation was effected, there would be no 
means of distinguishing it from death occasioned by con- 
striction of the cord, except where marks of the ligature 
have been left upon the neck of the child. The question 
then is. Does the cord ever leave such a mark upon the 
neck? The cases are extremely rare in which the cord 
leaves any mark identical with that produced by a ligature 
in actual strangulation. Elsasser states that of 327 cases 
of labor in which the cord was twisted around the child's 
neck, there was one fold of it in 228 cases ; two folds in 83 
cases; three in 13 cases, and four in 4 cases; yet in the 
whole series there was not a single instance in which the 
least mark, impression, or ecchymosis was visible. In some 
cases the cord was so tightly wound round both neck 
and body that it was necessary to divide it before delivery 
could be accomplished. There are some instances, reported 
by trustworthy authorities, in which the umbilical cord has 
left very positive marks upon the neck of the child, some- 
times a mere furrow or depression, and again distinct lines 
of a red or blue color, sometimes single, and at others two 
or three parallel ones. It is, however, extremely doubtful 
if a true ecchymosis or extravasation of blood ever results 
from compression of the neck by the cord; certainly there 



236 MEDICAL JURISPRUDENCE. 

can be no abrasion of the cuticle, as is frequently observed in 
cases of strangulation by a rough string or cord. Even a 
livid mark around the neck is not necessarily caused by an 
effusion of blood, and such marks will often be found to 
disappear on the establishment of respiration. It should also 
be remembered that, in fat children especially, if the neck 
be short and the body has been kept in a cold place, furrows 
and ridges may be formed in the folds of the skin, which, to 
an ordinary observer, might be suggestive of strangulation. 

Should a ligature be actually found around a child's neck, 
there could, of course, be no longer any question about the 
impression not being due to the umbilical cord. The usual 
defense in such a case is that the ligature was placed there 
by the woman herself, for the purpose of assisting her de- 
livery, and no medical evidence can disprove such a state- 
ment. If the strangulation has been accomplished by the 
hand, the impression left will usually be very distinct and 
suggestive, and totally different from that produced by the 
navel string, which, at most, leaves a broad, smooth inden- 
ture, with soft edges. 

The cord sometimes, by being coiled around the limbs, 
and body of the child, before birth, produces deep depres- 
sions in the skin. Even an amputation of a limb has been 
observed as an effect. 

(2) Protracted delivery is not infrequently the cause of 
the child's death, especially in first labors. It may be as- 
cribed either to congestion of the brain, resulting from the 
compression of the head, or to interruption to the circulation 
in the umbilical cord, through pressure, before respiration 
can be performed. In primiparous cases, the labor is very 
apt to be protracted, and the child large, often requiring the 
application of the forceps. In death from this cause, the 



INFANTICIDE. 237 

head will usually be found much elongated, with evidences 
of considerable pressure, and having a large caput succeda- 
neiim. The autopsy will disclose congestion of the cerebral 
vessels. 

(3) Debility. — A child may be born either prematurely 
or at full term, and soon die from constitutional weakness, 
either inherited or produced by causes acting upon it before 
birth. In such feeble children a very slight cause is suffi- 
cient to destroy life. Such cases are recognized by the 
immature condition of the body, and the absence of all other 
causes of death. 

(4) Hemorrhage from the cord is sometimes the cause of 
death in the newborn child, either from accidental rupture 
during the birth, or after its severence. The sudden prema- 
ture separation of the placenta will produce the same result. 
The child, under these circumstances, will exhibit a blanched 
and waxy appearance, together with a paleness and dryness 
of the internal organs, particularly of the heart and lungs. 
This will not, however, hold good where putrefaction of the 
body is advanced. The hemorrhage may be accidental, or 
the result of criminal design. In either case it may have 
arisen from laceration of the cord, or from an omission to 
tie it after birth. Dr. Reese witnessed one case of fatal 
hemorrhage of the cord some days after birth, in spite of 
every effort to control it. Casper, with his large experience, 
states that he never met with a fatal case of hemorrhage of 
the cord, although he had witnessed several where it had 
been cut off close to the navel. 

It would appear, from numerous cases reported, that fatal 
hemorrhage is less apt to follow when the cord is ruptured 
than when it is cut, probably for the same reason that a torn 
artery is less likely to bleed than one severed with a knife. 



238 MEDICAL JURISPRUDENCE. 

According to Wharton and Stille, it is the habit of the 
Indian squaws to break the cord, and then bind the fetal 
end with a strip of bark. Numerous instances are also men- 
tioned of rapid delivery in women in an upright position, 
where the child has suddenly escaped from the mother and 
fallen to the ground, rupturing the navel string, yet without 
any bleeding of consequence. We know that the instinct of 
some animals leads them to divide the cord with their teeth, 
while in others it is ruptured either by the fall of the 
young while the mother is standing upright, or else by her 
suddenly springing up when delivered in a recumbent 
position. 

The usual length of the umbilical cord is from eighteen 
to twenty inches ; but it frequently exceeds this, in one in- 
stance amounting to fifty-nine inches and in another sixty- 
nine inches. In ordinary cases of delivery in the upright 
posture, the child may fall a distance of twenty-eight to 
thirty inches to the ground without putting a strain upon 
the cord. But in most instances of this nature this distance 
would be diminished by the woman instinctively assuming 
more or less of a bending position at the moment of expul- 
sion. Still, it might happen that the cord might be unusu- 
ally short, or else wound round the child, in which case it 
could easily be ruptured. The point at which the rupture 
usually occurs is a few inches from the umbilicus. In some 
instances of sudden traction, where it does not break, the 
placenta attached may be dragged out by the weight of 
the child. 

5. Fractures. — These are chiefly confined to the head of 
the child, and may be produced during any period of ges- 
tation, either accidentally or otherwise, from blows, falls, or 
other injuries, such as the kick of a horse, etc. Other bones 
may, of course, be fractured by blows, or injuries sustained 



INFANTICIDE. 239 

by the mother during pregnancy. Sometimes when the 
result is not fatal to the child, the marks of bony union are 
visible after birth ; but in most such cases the child perishes 
at the time of the injury and is born prematurely, so that 
the question of infanticide hardly presents itself. Fractures 
of the skull may occur accidentally during labor, from a 
disproportionate size of the child's head, or some deformity 
or osseous tumor of the mother's pelvis. As such cases 
usually require instrumental aid, the injury may have been 
unavoidably caused by the forceps. Such fractures, how- 
ever, are rare, on account of the extreme mobility of the 
cranial bones upon each other, which allows of considerable 
pressure and reduction of the volume of the head. In these 
cases, as the child may survive sufficiently long to breathe, 
it is of importance to prove that the fracture was accidental 
and not criminal. In the former case, the fracture is nearly 
always on the parietal bones, sometimes in the frontal, but 
never in the occipital bone. It is usually a mere fissure or 
crack, very rarely a depression, unless great violence had 
been employed. In cases of criminal violence, the fracture 
would probably be stellated or depressed, the bones often 
being driven deeply in, and the brain even protruding, to- 
gether with laceration of the scalp and other marks of vio- 
lence. In a case in which the criminal fracture happened 
to be only slight, it might be impossible to distinguish it 
from one resulting accidentally at the birth. It should also 
be remembered that very extensive fractures of the child's 
skull may result from criminal violence, without any visible 
trace of injury to the scalp. There is also a possibility of 
mistaking a defective ossification of the bones of the cranium 
for fracture. This defect occurs usually in the parietal 
bones, and is caused by a deficiency in the bony spiculae, 



240 MEDICAL JURISPRUDENCE. 

which is replaced by a membrane that fills up the gap. 
The edges of the bones are thin and beveled, and show no 
marks of injury. A true fracture is evidenced by a red line, 
seen on removing the pericranium, by the edges of the bone 
being jagged and bloody, and by the absence of any mem- 
brane; there is also more or less effusion of blood in the 
neighborhood of a fracture. 

The cases that occasion the greatest difficulty are those 
in which the fracture is alleged to have resulted from the 
fall of the child to the ground, in consequence of a sudden 
delivery while the mother was in the erect position. Such 
cases, although comparatively rare, occur sufficiently often 
to require attention. They present no special marks by 
which they can be distinguished from cases of criminal 
violence. Some writers deny the possibility of this acci- 
dent, but others, including Casper, admit an occasional occur- 
rence. Dr. Reese made experiments on the bodies of twenty- 
five dead infants, letting them fall from a height of thirty 
inches upon a hard pavement. One parietal bone was found 
fractured in sixteen cases ; both parietals in six cases ; once 
the parietal and frontal ; once the frontal ; and once the 
occipital. The fractures, in most cases, occurred about the 
parietal protuberances. It should be remembered that it is 
easier to fracture the skull of a live infant than that of a 
dead one. So, also, it has been ascertained that when firm 
pressure by the thumbs and fingers is made upon the head of 
a new-born dead child, out of fifteen experiments, in seven 
long fractures of one or other parietal bones resulted; in 
the other cases the result was merely a depression of the 
bone. Hence, we must conclude that the possibility of such 
an accident should always be taken into consideration, in 
cases of concealed birth, when fractures of the skull are 
discovered. 



INFANTICIDE. 24 1 

2. Causes of Death after Birth. — These are both numer- 
ous and varied, (i) Congenital malformation and disease 
may exist ; but in most cases life may endure, though for a 
brief period, even in monstrosities. Some of these malfor- 
mations are remediable, others are not. If violence should 
be inflicted upon such beings for the purpose of destroying 
life, the evidences for its discovery are similar to those 
employed in other cases. 

(2) Exposure. — Under this head may be included all the 
different cases of abandonment of the new-born child. The 
new-born infant quickly perishes if not properly cared for 
in the way of food and clothing. Authorities generally 
agree that deprivation of nourishment for over twenty-four 
hours is likely to prove fatal. Fodere states the greatest 
length of time to be one or two days. Yet there are cases 
on record where the infant survived three days without any 
food, and exposed, at the same time, to the variations of 
the temperature. 

The proofs of death from exposure to cold are by no 
means positive unless the body be discovered frozen stiff, 
discolored and shriveled, naked or scantily covered, in a 
cold place, buried under stones or earth, its lungs affording 
evidence of previous respiration, the internal vessels gorged 
with blood, while the external ones are empty, the brain 
deeply congested, as also the lungs and right heart (Fodere). 
Under such circumstances and in the absence of all causes 
of death it may be ascribed to cold. 

The signs of death from starvation are to be sought for 
in the same general way. These are an emaciated and 
shriveled body ; a pale and wrinkled countenance, expres- 
sive of pain ; dry, tough, and yellowish skin ; the mouth, 
tongue, and fauces also dry ; the stomach and intestines 



242 MEDICAL JURISPRUDENCE, 

empty and contracted ; gall-bladder enlarged and bile usually 
found in the alimentary canal ; stomach inflamed in places ; 
the heart flaccid and the great vessels almost empty. Cases 
of infanticide by absolute starvation are rare. In order to 
establish the charge, it must be shown that the woman wil- 
fully kept the child without food, and with a criminal de- 
sign. Mere neglect or imprudence is not sufficient. In a 
suspected case of this kind, it is recommended to examine 
the contents of the stomach for starch and other varieties 
of food. 

There is no doubt that many young children are pur- 
posely exposed to the danger of starvation by putting them 
out to be nursed on improper as well as scanty food, as 
witnessed in the wretched system of baby-farming. 

(3) Wounds and Injuries. — These are frequently the 
cause of death in new-born children ; they usually prove 
rapidly fatal, and, as a rule, leave no signs of inflammation 
or its results to indicate that the wound was made during 
life. The best evidence of the ante-mortem character of 
the wound is the presence of coagula under and around it. 
These indicate that the circulation was going on at the 
time; but if the effused blood be liquid, the presumption 
is that the injuries were inflicted after death, and while the 
body was yet warm. An accidental wound upon the child 
(usually on the arm or leg) might be made by the knife or 
scissors employed in cutting the cord ; but in such a case 
there should be proof that the cord had been really cut, 
and not ruptured. 

Penetrating and punctured wounds, of apparently trifling 
character, may easily prove fatal to a new-born child. Thus, 
punctures made by a needle or stiletto into the fontanelles, 
between the vertebrae or under the orbit, are almost sure to 



INFANTICIDE. 243 

destroy life. Beck mentions the case of a midwife who was 
executed in Paris for kilHng several children by plunging 
a needle into the head as it presented itself at the mouth of 
the womb. He also cites the case reported by Dr. Under- 
wood, of a child who died in convulsions which could not 
be traced to any cause until after death, when a pin, that 
had accidentally gotten under the child's cap, was found 
inserted into the fontanelle. The cause of death in such 
cases may easily escape detection. If suspected, the skin 
should be carefully dissected off and spread out before the 
light, when the finest puncture can be detected. 

Dislocation and fracture of the neck {twisting of the 
neck) are occasional causes of death in new-born children. 
Of course, in such cases the defense w^ould ascribe it to 
accident in the efforts to disengage the child from the 
mother, and the fact of criminal interference could only be 
established by the attending circumstances. It should also 
be remembered that cases are recorded where other disloca- 
tions, as of the hip and knee, have taken place before birth 
as the results of any injury to the mother. 

'(4) Asphyxia in its various forms is the most common 
of all the means of destroying the new-born child. Ac- 
cording to M. Tardieu, whose ample experience extended 
over twenty-four years, four fifths of all the cases of infan- 
ticide that he had examined were due to some form of 
asphyxia. 

Asphyxia may be effected in various ways — as by suf- 
focation, strangling, hanging, or drowning, by smothering 
under the bed-clothes, by exposure to noxious vapors or 
gases, or by thrusting various substances into the mouth 
and nose. 

(a) Suffocation. — This is a frequent cause of accidental 



244 MEDICAL JURISPRUDENCE. 

death in new-born children, arising from neglect to remove 
it from the maternal discharges or from the bed-clothes, 
or to disengage its face from the membrane, or caulj which 
is sometimes spread over it, or to remove the mucus from 
its mouth and throat. In some cases the obstruction is 
caused by meconium, blood, or feces which have been 
taken in by aspiration, in the passage of the head through 
the outlet, or immediately after birth. Such instances of 
accidental suffocation usually occur when the woman is 
delivered without any assistance. 

Suffocation is a very frequent criminal cause of death in 
cases of infanticide. The facility with which it can be ac- 
complished, and the slight risk of detection, in consequence 
of the difficulty of distinguishing it from an accident, doubt- 
less cause it to be so often resorted to. A wet cloth simply 
placed over the mouth or thrust into the cavity, either 
before or after respiration, and pressure on the child's chest 
(though the latter might accidentally occur at birth, when 
the head is born and the body retained for some time and 
subjected to pressure in the outlet), foreign bodies intro- 
duced into the mouth and throat, such as tow, hay, feathers, 
ashes, etc. Such are the means commonly employed for 
suffocating the child. In one case a mass of dough had 
been forced down the throat so as to obstruct the larynx; 
in another, the back part of the throat was packed with wet 
sand ; and in a third, the respiratory passages were filled 
with cinders, drawn in suddenly by aspiration. A child 
may also be suffocated under the bed-clothes, or by ex- 
posure to the noxious vapors of sulphur, burning charcoal, 
the exhalations of privies, etc., and without leaving any trace 
of the real cause of death. 

Strictly speaking, the child cannot be said to be suffocated 



INFANTICIDE. 245 

unless it has first breathed ; yet in many cases the death is 
brought about before respiration is estabHshed — breathing 
is simply prevented. Under such circumstances it would 
be impossible for the examiner to ascribe the death to a 
criminal act, unless there existed very evident marks of 
undue violence. In every case of infantile suffocation, a 
careful inspection of the respiratory openings should be 
made, in order to detect the presence of foreign bodies. In 
true cases of suffocation the post-mortem signs are those of 
apnea generally — such as congestion of the right heart and 
venous system, and also of the brain ; but there are present, 
also, the punctiform ecchymoses under the pleura, pericar- 
dium, endocardium, peritoneum, and bronchi, so much 
insisted on by Tardieu. The lungs of infants, according to 
the best authorities, are not usually found engorged with 
blood. Tidy says : " If the child be vigorous and well 
developed, the muscular and elastic forces of the arteries 
and arterioles will be sufficient to drive the blood on after 
the heat has ceased to beat and respiration is prevented. 
Such lungs will, therefore, be found comparatively bloodless 
or anemic, but with a large amount of emphysema, or dila- 
tation and rupture of the air-cells, owing to the violent 
attempts at inspiration or breathing." 

If the death has resulted from pressure of the body 
under the bed-clothes, the head will be found flattened, the 
tongue protruding, the eyes half open, a frothy mucus 
escaping from the corners of the mouth, and the excrements 
voided. 

{h) Strangulation. — This is a not infrequent mode of 
child-murder. The marks differ according to the methods 
employed. Since, in criminal strangulation, much more 
violence is usually employed than is necessary, the neck 



246 MEDICAL JURISPRUDENCE. 

will be very apt to bear the impress of the fingers or of the 
ligature employed, and sometimes of both. At times there 
may be abrasion of the cuticle from the roughness of the 
ligature, and also ecchymosis surrounding the marks of the 
latter. 

In all such cases of infanticide, the usual defense set up 
is that the cord was placed upon the neck of the child to 
aid in its delivery; or else it will be attributed to the acci- 
dental encircling by it; this, however, would be disproved 
by the evidence of breathing. Even the marks of the 
fingers upon the throat, indicating throttling, will be at- 
tempted to be explained by referring them to the same cause. 

The question whether the marks of the cord in strangu- 
lation can be imitated if it is applied after death, must be 
answered in the affirmative, provided it is done very soon 
after death, and while the body is yet warm. 

The only difference between strangling and hanging, as 
a mode of child-murder, is the oblique mark of the cord 
about the neck of the latter. Hanging is certainly a very 
rare form of infanticide. 

(c) Drowning. — There are no signs to indicate death 
from drowning in the body of a child that has not breathed ; 
yet this form of infanticide has been known to be perpetrated 
criminally, as when a woman causes herself to be delivered 
in a bath, so as to retain the child under water, and thus 
prevent its breathing. After respiration, the signs of drown- 
ing are the same as in adults. Here the important medico- 
legal question is, Was the child alive or dead when thrown 
into the water? Generally it is the latter; hence the im- 
portance of an accurate inspection of the body to ascertain 
the existence of marks of violence, some of which would 
be positive evidence of antecedent death, while others 



INFANTICIDE. 247 

might possibly be ascribed to accidental causes. In all 
such cases the throat and air passages should be especially 
investigated for foreign substances. 

It should be remembered that a young infant may easily 
be drowned by the simple immersion of the face in water. 
Cases have occurred where, through unconsciousness, or 
in a very rapid delivery, the child is projected into a com- 
mode half full of water, where it would certainly perish by 
drowning if not soon rescued. A case of this nature — 
which did not, however, result fatally — occurred in the 
practice of Dr. Reese. The accident may happen to a 
woman mistaking the sensation caused by the pressure of 
the child's head on the perineum for the feeling of a desire 
to evacuate the bowels. Yielding to this impulse, and 
sitting upon the opening of a privy, a sudden pain will 
eject the child from the maternal parts, and in its fall the 
umbilical cord will be ruptured, or else, in rare cases, the 
placenta may be dragged out still attached, and the child 
will miserably perish. Cases of this sort occasionally 
occur, and it is extremely difficult, if not impossible, to 
distinguish these from cases of criminal infanticide, since 
they will both exhibit the same evidences of death from 
suffocation. In a criminal case, however, the accompany- 
ing circumstances may sometimes lead to the detection of 
the culprit, as when marks of blood are discovered in her 
bed-room, which may, perhaps, be traced to the privy ; or 
when the umbilical cord may be discovered cut and not 
ruptured ; or other circumstances be presented which would 
render the prisoner's account inconsistent with the theory of 
the accident. 

(d) Poisoning is an extremely rare form of infanticide, 
although it is a frequent mode of destroying young chil- 



248 MEDICAL JURISPRUDENCE. 

dren. One case is recorded of poisoning a child one day 
old with arsenic; the mother was acquitted upon the plea 
of puerperal insanity. 

The following general conclusions may be considered as 
warranted from the foregoing considerations: (i) Did the 
death occur naturally? (2) Could it have been prevented? 
(3) Is the mother guilty of not having used proper precau- 
tion? (4) Was the death caused by violence on the part of 
the mother? (5) If there are marks of violence upon the 
child, did the mother inflict them ? 

From what has been said upon this subject, it is evident 
that medical testimony is not always sufficient of itself to 
establish a charge of infanticide. So many cases, as we 
have seen, occur in which precisely the same medical signs 
are exhibited in both accidental and criminal death in new- 
born children, that the attending circumstances have to be 
depended upon m order to come to a decision. 

MODE OF CONDUCTING AN EXAMINATION IN A SUS- 
PECTED CASE OF INFANTICIDE. 

1. External. — A careful external inspection of the body 
of the child is first to be made. Note the color, sex, length 
(measured from vertex to feet), the presence or absence of 
putrefaction, wounds, bruises, injuries, stains, etc. Take 
the dimensions of the thorax, shoulders, and head ; also 
ascertain the weight and the center of the body, and note 
the condition of the umbilical cord. 

2. Internal. — Observe the shape and condition of the 
thorax ; the lungs, as to their position, volume, shape, and 
color ; their absolute and specific weight ; the position of 
the diaphragm ; the condition of the heart as to the foramen 
ovale and ductus arteriosus ; also the ductus venosus and 



INFANTICIDE. 249 

the umbilical vessels. In the abdomen, observe the stomach 
and intestines, the liver and bladder. Also notice the brain 
and spinal marrow. 

The Autopsy. — The first incision should be made com- 
mencing at the center of the lower jaw, and* extending 
to the lower end of the sternum. Some advise to divide 
the lower jaw at the symphysis, so as the more completely 
to expose the buccal cavity, in the search for foreign sub- 
stances ; this, however, may not be necessary. The posi- 
tion and appearance of the tongue are to be especially 
noticed. The larynx and trachea are next to be laid open, 
and as much of the esophagus as can now be seen. The 
incision is now to be carried down on each side of the spine 
of the ilia, and the triangular portion of the integuments 
thus shaped out is to be turned back, so as to examine the 
condition of the umbilical vessels. The abdomen is next 
to be opened, and the position of the diaphragm noticed. 
All the viscera are to be carefully inspected, together with 
the ductus venosus, behind the liver. The stomach and 
bowels are to be tried and removed in order to search for 
poison, if suspected. The gall-bladder and urinary bladder 
should be examined, also the presence or absence of me- 
conium in the large intestines be ascertained. 

The thorax should be opened with the scissors, preferably 
to the knife, at the junction of the costal cartilages. After 
examining the general appearance of the contents, all the 
great vessels are to be tied, and divided beyond the liga- 
tures ; the trachea is also to be divided at its root. The 
lungs are then to be taken out and weighed, and subjected 
to the hydrostatic test. The heart may now be examined 
as to the condition of the foramen ovale and ductus arterio- 
sus. The head may be examined by making one incision 



250 MEDICAL JURISPRUDENCE. 

from the root of the nose back to the neck, and another 
at right angles from ear to ear; strong scissors should be 
used in cutting through the bones. The brain is to be 
removed and inspected in the usual manner. The spinal 
cord will often require examination ; and sometimes also the 
vertebrae. 

The other two questions pertaining to the infant, in a 
case of child-murder, have reference to its age and the 
interval elapsed since its death. The age of the new-born 
child is to be determined by ascertaining if it exhibited the 
recognized character of a fully matured fetus. The exact 
interval of time that has elapsed since its death cannot be 
determined merely by a medical inspection. Many circum- 
stances would have to be considered, such as the season 
of the year, the temperature, the place where the body was 
discovered, etc., before the examiner could venture an 
opinion; and he should always be extremely cautious in 
the matter, seeing how uncertain are the signs on which 
that opinion is to be founded. 

It is necessary in every case of alleged infanticide to con- 
nect the condition of the reputed mother with that of the 
infant, so as to establish the fact that she has been actually 
delivered about the time when it is judged that the child 
was born. This is easy, in a recent case, if the mother is 
willing to submit to medical examination, but it is altogether 
different when a considerable interval has elapsed since the 
birth. 

The question, then, is. Has the woman under examina- 
tion been recently delivered? If the examination is made 
within three or four days after delivery, the following signs 
will usually be exhibited: there is more or less weakness, 
some pallor of face; the eyes a little sunken, with a dark 



INFANTICIDE. 25 I 

areola under or around them ; the skin is soft, moist, and 
relaxed ; the whole aspect resembling that of a person 
recovering from sickness. The pulse is soft and a little 
quickened ; the abdomen feels soft and relaxed to the touch, 
and is sometimes thrown into folds, and presents, on the 
surface, a number of transverse, livid lines, which, at a 
later period, become white and shining, or silver {linece 
alhicantcs). The uterus can be distinctly felt through the 
wall of the abdomen, low down, like a large ball. The breasts 
have a full and somewhat knotted feel ; they are generally 
enlarged, and the nipples are prominent and often exude a 
watery milk. 

The external organs of generation are swollen, relaxed 
and moist ; the vagina capacious, and without folds ; the 
OS uteri easily felt to be low, and somewhat patulous ; the lips 
soft and relaxed, and perhaps, slightly lacerated. The 
uterine sound will show the increased depth of the uterine 
cavity, and prove the tumor felt from the outside to be the 
womb. There will be a dark, muco-sanguinolent discharge 
from the uterus, known as the lochia, readily distinguish- 
able by its peculiar odor. The color of the lochia subse- 
quently becomes much lighter, or greenish ; this discharge 
usually disappears in a week or ten days, and in some 
instances it is suppressed. 

These signs combined form very satisfactory proof of 
delivery, although none of them can be relied upon singly. 
The condition of the genital organs affords the most con- 
clusive evidence. 

The linece alhicantcs may result from any distention of the 
abdomen, as ascites, uterine tumor, etc. ; they have even 
been seen in the male. The secretion of milk may be absent, 
and, again, it may occur in the unimpregnated condition ; 



2 52 MEDICAL JURISPRUDENCE. 

but the presence of colostrum among the milk corpuscles (to 
be determined by the microscope) may be regarded as con- 
clusive evidence of a recent delivery. The lochia and the 
relaxed state of the genital organs might be mistaken for 
the catamenia, except for the peculiar odor ; but the jagged 
or notched condition of the as uteri and its patulous state are 
usually to be attributed to a recent delivery. 

All the above signs of delivery fail completely after the 
lapse of five to ten days, except the still increased size of the 
uterus, and its rather open and jagged mouth, together with 
the silvery lines across the abdomen. The two last men- 
tioned signs would be positive evidence, provided this could 
be shown to have been the woman's first pregnancy, and 
provided, also, the absence of any other abdominal swelling 
could be proved. Otherwise, they only afford grounds for 
suspecting one or more former deliveries. 

Signs of Delivery in the Dead. — Supposing the woman to 
have died immediately after her delivery, the evidences of 
that fact will be sufficiently manifest. Besides the condi- 
tion of the external organs above described in the case of 
the living, on opening the abdomen the uterus will be found 
flat and flaccid, between nine and twelve inches long, and 
with the OS wide open. The cavity will contain bloody 
coagula, with the remains of the decidua lining the inner 
surfacQ. The attachment of the placenta will be marked by 
a gangrenous-looking spot. If the death has been delayed 
only a few days, the womb will be considerably modified ; 
and if three or four weeks have elapsed, it will be as diflicult 
to determine delivery in the dead as in the living. 

The fact of unconscious delivery must be admitted, as it 
is supported by positive evidence, and as it is in accord 
with the well-known instances of a similar character in 



INFANTICIDE. 253 

women when in coma, epilepsy, asphyxia, narcotism, and 
anesthesia from ether and chloroform, and also when in a 
profound natural sleep. 

Concealed Delivery. — In nearly every case of infanticide, 
it is the object of the woman both to conceal the body of her 
child and hide all traces of her delivery. The concealment 
of pregnancy is no offence in law, but the concealment of 
delivery or of the birth of a child is a misdemeanor. As a 
matter of fact and practice, however, women who are tried 
on this charge are punished, not for concealment of the 
birth, but for concealment of the body of the child — a dis- 
tinction which excites hope in the criminal that if she can 
do away with the body she may be free of the law. Ac- 
cording to statute, the child must be dead ; the concealment 
of a living body is no offense, unless it should happen to 
die before the birth was made known. In a trial for con- 
cealment of birth, the medical evidence is derived exclusively 
from the mother; the body of the child need not be pro- 
duced, and the special points which will engage attention 
are (i) the proofs of recent delivery; (2) the proofs of pre- 
vious pregnancy, and (3) the connection between the alleged 
period of delivery and the state of the child as found. 

Pretended Delivery. — This occasionally occurs for various 
motives, and sometimes without any assignable motive. A 
medical examination will detect the imposture, because the 
assumed delivery must be recent and not remote. The 
pretense may occur when the woman has never been preg- 
nant, when she had been pregnant, and when she had been 
dehvered, but had substituted a living for a dead child. 

Evidences of the Death of the Child before its Birth. — The 
question whether the child is dead in utero may require to 



2 54 MEDICAL JURISPRUDENCE. 

be determined in certain civil cases involving succession to 
an estate, contingent to the life of the child ; also in criminal 
cases — as where a pregnant woman has been maltreated, 
and her unborn offspring is alleged to be dead. During 
pregnancy, the life of the fetus is inferred from the general 
good health of the mother, although this is by no means a 
positive sign. The progressive increase in the size of the 
abdomen, together with the continuance of the fetal move- 
ments, though strongly suggestive of fetal life, are not abso- 
lute proofs. The only unequivocal sign is the sound of the 
fetal heart repeatedly heard by auscultation. 

The indications of the death of the fetus during preg- 
nancy are the cessation of all motion, after this has been 
positively felt by the woman. She experiences a sensation 
of a dead weight in the abdomen, along with a sense of 
lassitude ; the breasts are apt to recede, or become less 
prominent; there is pallor of the countenance, with a dark 
circle around the eyes ; the spirits flag, amounting at times 
to melancholy ; the breath is fetid. While these signs com- 
bined may excite a strong suspicion of the death of the 
embryo, the only positive and unequivocal proof of it would 
be the ascertained continuous absence of the beat of the 
fetal heart by means of the stethoscope. It is stated, on 
good authorities, that the placental murmur may continue 
some time after the death of the fetus. 

During delivery the signs of the child's life are limpidity 
of the waters, regularity of the pains, with increase in 
strength, pulsation of the cord, heart, and fontanelles. 

Putrefaction of the fetus generally occurs soon after its 
death in utero, and it is usually prematurely expelled within 
a few weeks ; but occasionally it is retained until the full 
term, and may even then not exhibit the marks of decom- 



INFANTICIDE. 255 

position. The various causes that may occasion the intra- 
uterine death of the child have already been described. 

The indications of the child's death during delivery are 
fetid discharges instead of limpid waters, absence of all 
motion, a livid appearance of the skin, no pulsation of the 
umbilical cord, the cuticle peeling off the head in flakes, 
and the bones of the cranium loose and floating. The 
lividity of the skin is not an invariable sign ; a case is men- 
tioned in which, in an arm presentation, this member was 
so livid and cold as to be supposed certainly to indicate the 
child's death ; it was consequently amputated, in order to 
facilitate the labor, but to the discomfiture of the obstet- 
rician, the child was born alive and survived. 

The general appearance of a fetus that has been dead 
some time before its birth has already been described. 



CHAPTER XL 
LEGITIMACY— INHERITANCE. 

The question of Legitimacy is one involving the nearest 
and dearest interests of social life, and one at times sur- 
rounded with no slight difficulties arising from the uncer- 
tainty of most of the evidence usually advanced. 

Cases involving the question of legitimacy are rarely 
decided upon medical evidence alone; there are usually 
circumstances which indicate the parentage of the child 
whose legitimacy is disputed. The important point for con- 
sideration of the physician is the duration of gestation. 

The following position may be considered as settled by 
the laws of this country and England: — 

I. Every child born in wedlock is presumed to be legiti- 
mate, unless it can be shown (i) that the parties had been 
separated for a time beyond the period of gestation ; (2) that 
the husband was impotent ; ( 3 ) adultery on the part of the 
wife and the repudiation of the alleged child by the hus- 
band. When the woman was so far advanced in pregnancy 
at the time of her marriage that her situation must have 
been known to her husband, this will be deemed as a 
recognition of paternity, and also of legitimacy, on his 
part. 

A child born after the death of its father or mother (as 
by the Csesarean section) is held to be legitimate, although, 
strictly speaking, the marriage tie is dissolved by death; 
hence, as remarked by Taylor, a child may be conceived 

256 



LEGITIMACY. 257 

before marriage, and born after the death of the mother or 
father, and yet be legitimate, although neither conceived nor 
born in wedlock. 

Duration of Gestation. — The usual popular notion upon 
this point is that it comprises nine calendar months (273 to 
275 days), or ten lunar months (280 days). Ten lunar 
months was the period allotted by the Roman law, which 
was also the opinion of Harvey, dating from the commence- 
ment of the last menstrual period. There seems to be a 
fair physiological presumption for this latter view, based on 
the idea that parturition occurs at the period of what would 
be the tenth menstrual effort since the last. 

The discordance existing on this subject arises partly 
from want of a definite starting-point. This is usually fixed 
by the woman by certain peculiar sensations supposed to be 
experienced at conception or at the period of quickening. 
The first is altogether fallacious, for conception may occur 
in the unconscious state. The second is equally uncertain, 
since the time of quickening varies so much in different 
women, — from the twelfth to the twenty-fifth week ; and in 
some it is not perceptive at all, whilst in others it may 
be supposed to exist even in the absence of pregnancy. 
The cessation of catamenia is the usual and the surest 
method of calculating, but it is liable to many fallacies, 
such as the arrest of the menses before pregnancy ; their 
continuance for a month or more after pregnancy, and the 
intervals between the periods not being the same in all 
women. Usually there is an interval of twenty-eight days 
from the commencement of one period to the commence- 
ment of another, but it is frequently longer or shorter, and 
this in the same woman at different times. As conception 
23 



258 MEDICAL JURISPRUDENCE. 

may take place at any period of the interval between the 
catamenia, it is evident there might be a difference of twenty- 
three to twenty-five days as to its actual date, according as 
it occurred immediately after the one catamenial, or imme- 
diately before the succeeding period. The usual custom 
among miarried women is to reckon nine calendar months 
from the last-mentioned period, and to add about fourteen 
days for possible error. There is a diversity of opinion 
among obstetricians of the highest reputation on the subject 
of the natural period of gestation — varying from 274 to 301 
days. It may be assumed that the average period is between 
thirty-eight and forty weeks. 

The most certain and positive starting-point from which 
to fix the date of conception is a single intercourse. Even 
where this can be accurately settled, still there will be found 
considerable discrepancies which must be attributed to in- 
dividual peculiarities, and which indicate that there is no 
absolute law on the subject. Observation shows periods 
varying from 233, 249, and 260 days, up to 293 and 313 
days. Even rejecting the two extreme cases of 233 and 313 
days (though they are perfectly authenticated), as very 
exceptional, we still have the great variation of forty-four 
days between the two extremes of 249 and 293 days, or of 
sixty days between the extremes of 233 and 293 days. 
Taking the average of fifty-six cases, dating from a single 
coitus, reported by various authors, ranging between 260 
and 296 days, it will be found to be 276 days. 

The irregularity as regards the normal period of gesta- 
tion in the human female finds its analogy among the lower 
animals. Extended observations made upon the cow, the 
mare, and the sheep confirm the results observed in the 
human female. In the cow the average period of gestation 



LEGITIMACY. 259 

is about 285 days ; yet, from Dr. Krahmer's tables, it is 
found that, out of 1,105 cows, 335 calved on the fortieth 
week, 429 on the forty-first week, and 135 on the forty- 
second week; the balance varied from the thirty-eighth 
week to the fifty-first week — a period of about 90 days. 

In sheep, the average time among 177 births examined 
was 150 days; yet the period varied from 145 to 171 days 
— a diflference of 26 days. 

In mares, whose normal term of gestation is about 300 
days, Tessier found, out of 102, that 21 went as far as 360 
days and one as far as 394 days. 

The logical conclusion from the above statements must 
be that it is possible for human pregnancy to be prolonged 
beyond the usually admitted normal period ; but the ques- 
tion how far beyond is rather difficult to answer; though 
the greater the amount of deviation, the stronger and more 
convincing should be the proofs. 

It is an error to suppose that a protracted pregnancy is 
accompanied by an increased size of the child, although, 
physiologically considered, the fetus ought to continue to 
increase in size in liter after the usual term of gestation. 

The celebrated Gardner Peerage Case well illustrates 
many of the above points. Lord and Lady Gardner parted 
from each* other on January 30th, 1802. The husband re- 
turned on July nth of the same year. During his absence, 
his wife was known to be living in adulterous intercourse 
with a Mr. Jadis. She was delivered of a son on the 8th 
of December, three hundred and twelve days after Lord 
Gardner's first absence and one hundred and fifty days 
(about five months) after his return. The child was perfectly 
developed and mature at its birth, so that the idea of a 
premature birth was not entertained, and the only question 



260 MEDICAL JURISPRUDENCE. 

was as to the possibility of a protracted gestation. The 
ablest obstetrical experts were engaged on both sides at 
the trial, and, as usual, there was a difference of professional 
opinion upon the subject, some maintaining that the period 
of gestation was absolutely fixed, while others (the majority) 
admitted the possibility of its being protracted. The case 
was decided against the claimant (the alleged son), not, 
however, on the ground of the protracted period of his birth, 
but on the ground of his mother's notorious adultery and her 
concealment of his birth. 

A circumstance often lost sight of in this discussion is 
that conception is not always synchronous with intercourse 
or insemination. The former occurs only when the sper- 
matozoids come in actual contact with the ovum. This 
may take place in the uterus or in the Fallopian tube, and 
several days may elapse after intercourse before it is actu- 
ally accomplished. The spermatozoids are known to retain 
their vitality for a period of several days within the vagina ; 
and as fecundation cannot result until these meet the ma- 
tured ovum (which requires a variable period for its descent 
from the ovary), conception might be delayed as long as 
seven days. This does not explain the lengthened varia- 
tions of gestation above noted. As Taylor remarks : " We 
must be prepared to admit either that conception may, in 
some cases, be delayed for so long a period as five to seven 
weeks after intercourse, or that there may be a difference of 
from five to seven weeks in the duration of pregnancy." 
Winckel states that a pregnancy may vary from 240 to 320 
days and even exceed the latter limit. Nearly seven per 
cent, of the cases are over 300 days. 

11. Premature Birth. — Diminished Period of Gestation. — 
Early Viability. — An important question in connection with 



LEGITIMACY. 26 1 

legitimacy is, whether a child, in all points fully developed, 
can be born before the ordinary period of gestation? Its 
bearing upon the subject of legitimacy is direct and im- 
portant. For instance, a husband, after a long absence, 
returns to his wife, and a fully developed child is born after 
seven or eight months. Is this a legitimate child? The 
question is about as difficult to determine as the former one 
concerning a protracted pregnancy. It must be admitted 
that children at full term differ extremely in size, weight, 
and in apparent maturity, so that some eight months' chil- 
dren may appear better developed than some at nine months. 
This, however, is the exception and not the rule. Again, 
it is known that some women always give birth to their 
children before the full term ; but these may be regarded 
as cases of diseased action. The probabilities are strongly 
against it. 

Again, since in cases of prolonged gestation the children 
do not continue to grow in utero after their full period, it 
would seem still less probable that, in the earlier months 
of fetal existence, they should be one, two, or three months 
in advance of their normal intra-uterine life. Dr. Mont- 
gomery states that he never saw a seven months' fetus pre- 
sent the remotest appearance of the fully matured child. 

It seems, therefore, that while in some instances there 
may be a doubt about an eight months' child, on account 
of its advanced degree of development, there ought to be 
no doubt whatever in the case of a six or seven months' 
child. The peculiar characters presented by the fetus at 
these ages have been given. 

In an English case, in which the question of the legiti- 
macy of a child was made to depend upon the period of the 
mother's gestation — 259 days or 37 weeks (or three weeks 



262 MEDICAL JURISPRUDENCE. 

lacking maturity) — Simpson gave evidence that a child born, 
perfectly matured, three weeks before the usual term, could 
not be legitimate. This is certainly stronger ground than 
many would take. To stamp a child as a bastard, and to 
impute the crime of adultery to the mother, because of the 
three weeks' prematureness of the birth, even though ap- 
parently mature, is an assumption not warranted by num- 
erous facts. 

As regards the earliest viability of a child, or the earliest 
period of intra-uterine life at which it is capable of living, 
there is a universal admission that an eight or even a seven 
months' child may survive ; 'that occasional instances have 
occurred where a six months' infant lived; and that a very 
few exceptional cases have been recorded of the survival of 
children born a little over five months. An infant born 
earlier than this period could not be considered viable. 

The question of premature birth may present itself under 
a civil aspect, that of survivorship, when a living child 
acquires civil rights — such as inheritance and the transmis- 
sion of property. In such a case it becomes a matter of 
vital importance to establish the fact that the child, when 
born, was actually alive. The laws of this country and of 
England do not require that the child should be viable, i e., 
capable of continuing to live, but only that it should be 
born alive. It matters not whether it be mature or imma- 
ture, so that it was alive. 

What, then, constitutes a live birth? Anything that will, 
prove that the child was living at the time of its birth. 
According to the laws of the United States and England, 
neither breathing nor crying are essential to establish a live 
birth ; the pulsation of the child's heart, or of one of its 
arteries, or the slightest voluntary movement, is regarded 



LEGITIMACY. 263 

as sufficient for this purpose. In Scotland, crying is re- 
garded as essential ; in France, respiration ; and in Germany, 
crying, '* attested by unimpeachable witnesses." According 
to Blackstone, crying, indeed, is the strongest evidence, but 
it is not the only evidence ; and Coke remarks — " If it be 
born alive, it is sufficient, though it be not heard to cry, for 
peradventure it may be born dumb." 

With this clear and definite understanding of what is 
legally regarded as the proofs of a live birth, we must 
admit that fetuses have been born alive as early as four 
months, and, of course, at all periods of a later date. Such 
a case is reported by Dr. Erbkam, of Berlin, in which the 
fetus was only six inches long and weighed but eight 
ounces ; it survived half an hour ; it moved its legs and 
arms, turned its head from side to side, and opened its 
mouth. Miiller pronounced this fetus to be not over four 
months old. Dr. Barrows, of Hartford, reports another 
case, especially interesting from the fact that the exact 
period of conception could be fixed; miscarriage took place 
at 144 days — less than five calendar months. The ovum was 
expelled entire. Before rupture of the membranes, the 
movements of the child were vigorous. After the rupture 
it cried out very distinctly ; the cord was tied on ceasing to 
pulsate, after which it breathed with a gasp for forty 
minutes; it repeatedly opened its mouth and thrust out its 
tongue. It measured ten inches long and weighed four- 
teen ounces. 

Tenancy by Courtesy. — This phrase signifies, accord- 
ing to Blackstone, " a tenant by the courts of England," 
and is applied to the case in which a husband acquires a 
life-interest in the property of his wife at her death, pro- 



264 MEDICAL JURISPRUDENCE. 

vided a child was born of the marriage, Hving, during the 
wife's Hfe. " In this case " (in the old law language) " he 
shall, on the death of his wife, hold the lands for his life, 
as tenant by the courtesy of England." If there should 
be no living issue, the property would pass to the heir-at- 
law. In every such case the following conditions must be 
settled: (i) There must be proof of a live birth. We 
have already adverted to the proofs required to establish a 
live birth in different countries. (2) The child must be 
born while the mother is living. This was the old dictum 
of Lord Coke some three hundred years ago. Hence, if 
a living child were extracted by the Csesarean section from 
a dead mother, it could not transmit an inheritance. It is 
not certain that this doctrine would be followed by modern 
courts. (3) The child must be born capable of inheriting; 
therefore, a monster cannot inherit or transmit a property. 
It is difficult to give a legal definition of a monster. Clearly, 
no mere external deformity or internal malformation would 
constitute such a disability. Lord Coke defines a monster 
as " a being that hath not the shape of mankind." Thus, an 
acephalous, dicephalous, or disomatous creature would seem 
to be excluded. St. Hilaire's distinction in relation to such 
beings is usually followed, viz., to consider every monster 
with two equally-developed heads, whether disomatous or 
not, as two distinct beings ; and every monster with a single 
head, disomatous or not, as only one being. It is difficult to 
say how such a ruling would apply as to the exclusion of 
the Siamese twins and other similar cases. In several of 
our own States, the old English law of the " Tenancy by 
Courtesy " still prevails. Dr. Reese was once called as an 
expert, in the State of Delaware, to determine the fact of 
the live birth of a child which had neither breathed nor cried. 



LEGITIMACY. 265 

but whose heart and temporal arteries had pulsated for sev- 
eral minutes after birth. One of the parties to the suit 
adopted the usual course in such cases, namely, to assert 
that these acts of the circulation were only the remnants of 
uterine life, and could not be considered as evidences of an 
independent life on the part of the infant; but it was con- 
clusively show^n that every action of a person's life may, in 
one sense, be regarded as the remnant of uterine life, and 
that, as such acts could not be performed by a dead child, 
the only alternative was to admit that it was alive. More- 
over, several cases were cited, both English and American, 
in which the live birth was sustained on much slighter proofs 
than the above. 

Lazi's Concerning Legitimacy. — The Roman law did not 
consider a child legitimate if born later than ten calendar 
months after its father's death. The French law allows the 
legitimacy of a child born i8o days (or six calendar months) 
after marriage, and 300 days after the death or non-access 
of the husband. The Prussian law declares a child legiti- 
mate that is born within 302 days after the husband's death. 
In Scotland, the legitimacy of a child is established if it is 
born 168 days (six lunar months) after marriage, and within 
ten months after the death of the husband. In the Jadine 
case, the General Assembly of the Church of Scotland pro- 
nounced in favor of the legitimacy of the child, which was 
born 174 days after marriage. 

In this country and in England there is no law regulating 
the exact period of gestation in relation to legitimacy, each 
case being decided on its own merits. In the United States, 
in one instance, legitimacy was allowed where the time was 
317 days; and in another case, affiliation was allowed where 
24 



266 MEDICAL JURISPRUDENCE. 

the period was 313 days. In England it was disallowed 
when the time was 311 days (Gardner Peerage Case) ; but, 
as was remarked above, the moral circumstances of this 
case, rather than the question of a protracted gestation, 
influenced the decision. 

Minority and Majority. — In law the word minor or in- 
fant signifies a person under the age of twenty-one years. 
Before this age, he or she is regarded as incapable of per- 
forming certain civil acts, such as serving on a jury, making 
a will, executing a deed, or other contract. The law has 
fixed no age for competency as a witness, the court judging, 
in individual cases, of the mental capacity of the child. It 
is usually held that a child up to seven years is incapable 
of distinguishing right from wrong, and is, therefore, legally 
incapable of crime. At fourteen a child is considered to 
have arrived at years of discretion, and it then becomes 
responsible for its actions, as for murder or rape. 

A person attains legal majority the first instant of the 
day before the twenty-first anniversary of his or her birth- 
day, although forty-seven hours and fifty-nine minutes short 
of the complete number of days, counting by hours. This 
is on the principle that the law takes no account of part of 
a day. Hence the importance of noting the exact day and 
hour of a child's birth, as a few minutes or hours may thus 
determine the attainment of majority. 

The date at which minority ceases is subject to deter- 
mination by statute, and hence the rule may vary in differ- 
ent States, and a different age may be fixed for each sex. 

Paternity — ^Affiliation. — The question of Paternity may 
present itself under various forms ; as, when a woman 
marries a month or so after the death of her first husband, 



LEGITIMACY. 26/ 

and a child is born in about ten months afterwards ; also 
when a supposititious child claims to be heir of an estate; 
and still more frequently, in cases of bastardy, when the 
putative father is obliged to support the child. In all such 
cases likeness to the parent is regarded as strong presump- 
tive proof of paternity, requiring, however, further corrob- 
oration. This paternal resemblance extends not only to the 
features, but also to the voice, gesture, attitude, and habits. 

Paternal likeness may obviously be shown by color, as 
where a white woman gives birth to a mulatto or Mongo- 
lian child, or z'ice versa. 

Personal deformities are sometimes, though not always, 
transmitted from parent to child ; but, certainly, it would 
not be safe, in a disputed case of paternity, to make the 
decision solely to depend on this. In some alleged cases 
of this nature, it is quite possible that the mind of the 
woman, while pregnant, might have been influenced by the 
mere sight of the deformed man alleged to be the father of 
her child. 

In the Douglass Peerage Case this question of paternity 
was the turning point as to whether the claimant, Archi- 
bald, was the true and lawful heir to the title and estate. 
The case was tried in 1767, in the Court of Session, in 
Scotland, and lasted eight days. Out of fifteen judges, 
eight decided against the appellant. The case was then 
appealed to the House of Lords, which reversed the former 
decision. Lord Mansfield delivered the judgment, and took 
occasion to express a very decided opinion in favor of the 
parental likeness which the claimant bore to his father as 
constituting an important link in the chain of evidence. 

A case of affiliation may present itself in which a child 
born of a woman who has had intercourse with two men 



268 MEDICAL JURISPRUDENCE. 

within a few days of each other is affihated upon one of the 
men rather than upon the other. Hence it would be impos- 
sible to settle the question by a mere medical opinion. The 
circumstances of color, or other likeness, or some accident, 
might assist in determining the question. 

Connected with the question of paternity there is a curi- 
ous physiological fact that might occasionally be supposed 
to affect the decision. It is believed by breeders of horses 
and cattle that the influence of the impregnation by one 
sire may be extended beyond the foal begotten at the time 
and affect those begotten subsequently by another sire. This 
is proven by the later colts or calves bearing the peculiar 
markings of the first sire. The question, therefore, might 
be suggested whether this same handing down of parental 
likeness to the children of a subsequent father might be 
possible ? Without any positive data on which to venture an 
opinion, it may, nevertheless, be suggested here as a circum- 
stance to be considered in certain cases of affiliation. 

Superfetation. — By this term is implied the conception 
of a second embryo in a woman already pregnant, and the 
birth of two children at one time differing considerably in 
their maturity, or of two births at different times of mature 
children. The possibility of a second conception after a 
successful impregnation is denied by some authorities; but 
the proof of it is abundantly established by the fact of a 
woman giving birth to two children of different colors, and 
her admitting to have had intercourse with a white and a 
black man successively. It must also be accepted as pos- 
sible in the case of a double uterus. The usual explanation 
given by those who reject the doctrine is that there was 
a twin conception, and that one of the embryos became 



LEGITIMACY. 269 

blighted in early uterine life while the other continued to 
be developed. This explanation may cover some cases of 
alleged superfetation, but certainly not all, as when two 
perfectly mature children are born three or four months 
apart, and especially when two children of different color 
are born together, or one soon after the other. 

It has been maintained that superfetation is impossible, 
because of the physical obstacle to the entrance of the 
seminal fluid into the mouth and neck of the uterus caused 
by conception. This, however, has been denied by Dr. 
Duncan, who has shown that the mouth of the womb is not 
immediately closed after conception, and that communica- 
tion between the vagina and ovary is not cut off for several 
months after impregnation, and that there is no impediment 
to the ascent of the spermatozoids. Others attribute the 
rarity of superfetation, not so much to any mechanical 
impediment, as to the absence of proper ovules, ovulation 
being of rare occurrence in the pregnant condition. 

Double conception has been observed in the lower animals, 
as in a mare covered successively by a horse and an ass : she 
produced at the same birth a horse and a mule. 

The result of all the observations made upon this subject 
is, that the majority of the alleged cases of superfetation 
may be explained ( i ) upon the theory of twin pregnancies, 
where one fetus has grown at the expense of the other, 
and is first expelled, the other remaining until it has ac- 
quired the proper maturity; (2) by the existence of a double 
uterus. Nevertheless, there are a few other cases which do 
not admit either of these explanations, and which cannot be 
accounted for except on the theory of two successive con- 
ceptions. 



270 MEDICAL JURISPRUDENCE. 

Doubtful Sex — Hermaphroditism. — The latter term 
strictly applies to those cases in which the organs of both 
sexes exist in the same individual ; but it is now commonly 
employed to designate all cases of doubtful sex. With the 
defective sexual development there are usually associated 
certain peculiarities which indicate the preponderance of 
the characteristics of one sex. Until the period of puberty 
it is often difficult to determine the particular sex of the 
individual. At this epoch, however, certain changes usually 
occur that show the preponderance of either the male or 
female sex, such as change of voice, greater development 
of the shoulders or hips, the appearance of a beard, the 
development of the breasts, etc. The mere absence of 
testicles does not prove that it is not a male, since the testes 
sometimes never descend into the scrotum. Neither does 
the presence of a beard and whiskers necessarily indicate 
that it is not a female. Women have been seen with as 
flowing a beard as is found on most males. In some cases 
an external examination may fail to indicate the sex ; the 
clitoris may be mistaken for the penis, the labia for the 
scrotum, and the prostate gland for the uterus. Even a 
post-mortem examination may not always succeed in clear- 
ing up the uncertainty. 

Important medico-legal relations may have to "be deter- 
mined in cases of doubtful sex. Such beings, on account 
of imperfect sexual development, may be impotent and 
sterile, hence questions of divorce, legitimacy of offspring, 
paternity, and affiliation may be raised. Such beings cannot 
be deprived of the right of inheritance, nor in the United 
States of the right of voting, if medical testimony shows 
a preponderance of the male peculiarities. In case of in- 
heritance depending upon the sex of the offspring, when 



LEGITIMACY. 2/1 

the estate and title descend to the first-born male, if the 
oflPspring should prove to be of doubtful sex the prepon- 
derance of the male peculiarities would have to be clearly 
established by a medical examination before the inheritance 
could be claimed. 

A very extraordinary case of successful concealment of 
sex is that of Dr. James Barry, who was Staflf Assistant 
Surgeon in the British Army, and who died in 1865, at 
eighty years of age. This person was really a woman, as 
was proved by an autopsy. During this long period she 
had managed effectually to conceal her sex, although effemi- 
nate in appearance and without beard. She passed her 
medical examination and served in the army in different 
quarters of the globe, and exhibited all the usual qualities of 
a good soldier during her active life. 

IMPOTENCE— STERILITY. 

Impotence, or the want of procreative power in the male, 
may be functional or organic. The functional causes in- 
clude debilitating diseases, masturbation, opium and alcohol 
habits. The organic causes comprise malformation of the 
genital organs, such as deficiency of the penis, fistula in 
perineo, castration of both testicles, cancer or other malig- 
nant disease of the testes, and malformation of the urethra, 
as hypospadias and epispadias. Some of these defects are 
remediable, while others are not. The mere absence of the 
testes from the scrotum does not produce impotence, for such 
persons (crypsorchides) are capable of begetting children. 

In professional language, the term impotence is applied 
to the male, while the term sterility usually refers to the 
same condition in the female, including both a physical 



2/2 MEDICAL JURISPRUDENCE. 

sexual incapacity for intercourse and also unfruitfulness. A 
distinction, however, should be made. Strictly speaking, 
the male may be sterile without being impotent, as is seen 
in cases after castration and in some crypsorchides ; or he 
may be impotent without being sterile, as when intercourse 
is prevented by physical malformation, although the testes 
may secrete healthy semen. Again, the female may be un- 
fruitful without being incapable of intercourse, or vice versa. 
As regards the legal disqualification of the male on the 
ground of impotency, all that is necessary to prove is simply 
impotence or the incapacity for intercourse. In the female, 
incapa;city for sexual intercourse (not sterility) can alone 
be adduced as a ground for divorce. 

The procreative power in males usually commences at 
puberty with the full development of the sexual organs, 
especially the testes. The exact age of male puberty varies, 
but it may be stated to be from fourteen to seventeen years. 
Until this period is attained the semen does not contain 
spermatozoids, on which alone its fecundating power de- 
pends. Doubtless, certain cases of sterility are dependent 
on the absence of these from the seminal fluid. It would 
also appear that the power of impregnation is dependent on 
the activity of movement of these little bodies. The im- 
potence of old age in the male is probably owing to the feeble 
motion of the spermatozoids, rather than to their deficiency. 

The procreative power in the male may continue to very 
advanced age, if conjoined with sound bodily health. Sper- 
matozoids have been found in the semen at the age of 
eighty years, and even above. Certain diseases impair and 
destroy this power, such as disorders of the brain and spinal 
cord, dropsy, malignant fevers ; also blows on the head and 
spine. 



LEGITIMACY. 2/3 

Procreative power in the female. — The term sterility, 
when applied to the female, is usually understood to mean 
an inability to conceive. This power is manifested at 
puberty, or when the function of menstruation first appears. 
The precise age when this occurs differs in different coun- 
tries and with individual females, the usual earliest periods 
being twelve and thirteen years (some exceptional cases as 
early as under one year and upward), and the latest periods 
nineteen to twenty-three years. Conception, however, may 
take place in women who have never menstruated ; and in 
a few exceptional instances the function never occurred 
throughout life, although the woman may have given birth 
to several healthy children and enjoyed good health herself. 

Instances of premature puberty are not uncommon. 
Cases are reported where girls, one, two or three years old, 
have exhibited the physical development of grown women, 
and in whom the catamenia appeared at this early age and 
the function was regularly performed. Menstruation ceases, 
in the majority of cases, at forty to fifty years of age, but 
there are many exceptions. As it may commence early so 
it may terminate late — even up to sixty or seventy years, 
and in some remarkable instances even to eighty or ninety 
years. 

The continuance of menstruation is usually indicative of 
the power of conception. Its termination nearly always 
marks the cessation of the woman's ability to bear children. 

It is undeniable that women have conceived after the 
cessation of the catamenia. The latest age for pregnancy 
cannot be absolutely fixed, although it is comparatively rare 
after forty-five years, and almost unknown after fifty-five 
years. 

The causes of sterility in the female are various ; some 



274 MEDICAL JURISPRUDENCE. 

are organic, such as absence of the uterus or the ovaries, 
or disease of these organs ; imperforate vagina or hymen ; 
ovarian and uterine tumors ; occlusion of the os uteri by 
constriction; malposition of the uterus, etc. Other causes 
are functional, as debility, excessive leucorrhea, dysmenor- 
rhea, amenorrhea, menorrhagia, etc. It must also be re- 
membered that women may be sterile with one man and 
fertile with another. It not infrequently happens that a 
woman who has been married for years without issue, in 
contracting a second marriage may have several children. 

Legal Relations. — A suit for divorce may be procured 
by either party on the ground of impotency, provided it 
can be shown that the incapacity existed at and before mar- 
riage, and that it could not be remedied. There should be 
no delay in bringing the suit, and there should be proof that 
the incapacity was unknown to the complaining party at the 
time of the contract. If the alleged cause has supervened 
after the marriage, there can then be no grounds for a 
divorce. To sustain this charge of incapacity a medical ex- 
amination is essential, but this must be voluntary on the part 
of either the man or woman ; the courts cannot compel it. A 
mere unwillingness to submit to sexual intercourse on the 
part of a wife, or what the law terms a '' frigidity of con- 
stitution," would not justify a legal divorce. There must be 
proof of sexual incapacity from physical defect in either 
party. 

Certain cases of hysteria and vaginismus, where intol- 
erable pain, and even spasm, is produced in the woman at 
every attempt at intercourse, might possibly be regarded as 
affording legal grounds for a divorce. It was so determined 
in one case of hysteria in England ; but as the other affection 
(vaginismus) is often remediable, it is doubtful if the courts 
would regard this as a sufficient cause for granting it. 



CHAPTER XII. 
RAPE. 

Rape is legally defined to be the " carnal knowledge of 
a woman forcibly and against her will." A more correct 
and comprehensive definition would be " carnal knowledge 
without her conscious permission, or with such permission 
extorted by physical violence or fraud." Physical force, 
such as bodily injuries or partial strangulation, is not re- 
quired by the law in order to constitute this crime ; the 
employment of narcotics, anesthetics, or hypnotism, or the 
use of any fraud or pretence by which the will or under- 
standing of the woman is influenced or overcome, is suffi- 
cient to bring the act within the limit of the law. 

In ancient times this crime was variously punished by 
death, castration, fine, and imprisonment. At the present 
day, both in our own country and Great Britain, it is re- 
garded as a felony, and is punished by imprisonment or 
penal servitude for a term of years. In England, until the 
present reign, death was the punishment for rape. 

As this crime is usually committed in secret, and without 
witnesses, the law receives the evidence of a single person 
(the prosecutrix) as sufficient to establish the charge. As, 
however, false accusations are exceedingly common, med- 
ical evidence is generally required as corroborative proof. 
In former times the law required proofs both of penetra- 
tion and emission on the part of the male ; at present it is 
only requisite to adduce proof of vulval penetration, even 
without rupture of the hymen. 

275 



276 MEDICAL JURISPRUDENCE. 

Rape on young children is more common than on adult 
women, and for this several reasons are assigned. The 
most obvious one is the comparative facility of the attempt, 
on account of the feebleness of resistance and the ignor- 
ance of children. Another reason alleged, particularly in 
Europe, is a superstition prevailing among the lov^er orders 
that an obstinate gonorrhea is most certainly cured by 
having intercourse with a virgin ; and, therefore, a young 
child is selected for this purpose. 

Most civilized states have fixed a limit of age, below 
which the act of intercourse is rape, even when permitted 
by the child. This is known as the " age of consent." It 
is not uniform in all countries; but in most of the United 
States a female under ten cannot consent to sexual inter- 
course. In cases of the idiotic, or feeble-minded, or insane, 
the consent of the female is usually regarded as not excus- 
ing the criminality of the act; but each case must be de- 
cided according to the circumstances, such as the degree of 
mental imbecility, the proof of consent, and the employ- 
ment of force on the part of the male. 

In the case of an alleged rape, the duty of the physician 
summoned is, first of all, to make a note of the exact time 
and date of his examination, since this may hereafter serve 
an important purpose in determining if the prosecutrix took 
the earliest opportunity to complain. The time of the alleged 
offense should also be noted, as this may also involve the 
validity of an alibi. The female should be visited without 
giving her time for preparation, and the examination at once 
be made ; but it should be remembered that this examination 
cannot be made without her full consent, and it is highly 
advisable that such consent should be given in presence of 
a witness. Examination of a female without her consent 



RAPE. 277 

constitutes an indecent assault for which the physician may 
be punished. It is probable that the courts would make no 
departure from this principle even if the examining physi- 
cian is a woman. Medical evidence is derived (i) from 
marks of violence about the genital organs ; (2) from bruises, 
wounds, or other marks of injury on the person of the 
woman, and also of the accused as denoting resistance on 
the part of the woman; (3) the presence of spermatic and 
blood stains on the person or clothing, or either, or both ; (4) 
the existence of venereal disease on one or both. 

Unless the examination be made very soon after the act, 
all traces of it may have disappeared. Three or four days 
may suffice for this ; yet in many cases days or months 
elapse before an examination of the alleged victim is insti- 
tuted, and mistakes consequently often result. Casper states 
that in fifty-eight cases he examined, the time that had 
elapsed from the alleged commission of the rape varied 
from three weeks to one year. 

Rape on Children. — The fact of the greater frequency of 
rape upon children has already been stated. Out of 11 1 
cases examined by Casper, the ages were as follows : 
seventy-eight from two and a half up to twelve years ; seven- 
teen from twelve to fourteen years ; seven from fifteen to 
eighteen years ; and seven from nineteen to twenty-five 
years. It is quite probable that nearly this proportion would 
be found to exist also in other countries. It should not be 
forgotten that many alleged cases of rape on young children 
are entirely fraudulent, trumped up (often by mothers) 
chiefly for extorting money. All the authorities mention 
numerous instances of this character. Casper states that out 
of thirteen cases examined he found nothing whatever to 



2/8 MEDICAL JURISPRUDENCE. 

support the accusation, although other physicians had pro- 
nounced them genuine, and some of them even exhibiting 
marks of chancre! In all genuine cases the genital organs 
should exhibit marks of injury, if the act has been completed, 
and especially if any resistance was made, such as laceration 
of the pudendum, the effusion of blood, and bruises of the 
neighboring parts. It is manifestly impossible, from the dis- 
proportion between the sexual organs, that a rape could be 
perpetrated by a man upon a young child without being 
attended with severe local injuries to the latter. 

If the child be examined within two or three days after 
the act, the following signs will usually be found : inflam- 
mation and tumefaction of the vulva, with some abrasion of 
the mucous membrane ; a muco-purulent discharge- from 
the vagina, of a yellowish or greenish-yellow color and ropy 
consistence, staining and stiffening the girl's linen ; painful 
urination, arising from the inflammation being extended to 
the urethra ; clots of blood lying within the vulva and blood 
oozing from the abraded membrane. The hymen may be 
found either destroyed or lacerated, or very possibly not 
injured at all. In relation to the condition of the hymen in 
very young children, it should be remembered that in them 
it presents a variety of conformation, sometimes being very 
far back in the vulva, so as to render it difficult to find; 
in such cases it may entirely escape laceration. In fifty-four 
cases of actual rape upon children, many of them under 
fourteen years of age, and complicated with syphilis, Casper 
found the hymen uninjured in four fifths of the number. 

Unnatural dilatation of the vagina may be mentioned as a 
frequent sequence of rape on young children ; but this con- 
dition may be produced by the passage of hard bodies in 
order to substantiate a false charge. Casper once examined 



RAPE. 279 

a girl only ten years old whose mother had gradually dilated 
her vagina with her fingers in order to fit her for sexual 
intercourse. 

In making an examination, in the case of an alleged rape 
on a child, several points are to be considered. In the first 
place, it should be recollected that for the legal establish- 
ment of the crime, both in children and adults, it is only 
necessary that vulval penetration, however slight, be proven. 
It is not required that the hymen should be destroyed. It 
has been so decided repeatedly. If after an early exami- 
nation no marks of violence about the sexual organs or 
other portions of the person are discovered, this would be 
a strong presumption against the validity of the charge. On 
the other hand, the mere presence of marks of violence about 
the pudendum is not of itself sufficient to prove a rape, since 
these are sometimes inflicted purposely upon young children 
by designing mothers in order to make out a false charge 
against an innocent man. Further, the absence of the hymen 
is not of itself a proof of rape, since this membrane may have 
been previously destroyed by suppurative inflammation, or 
by ulceration, also by accident, or even designedly, in order 
to substantiate a false charge. 

The question whether venereal disease could be com- 
municated to young children otherwise than by sexual con- 
tact must be answered affirmatively, as by the use of sponges 
or cloths which have been previously employed by adults 
affected with these disorders. Such instances, however, are 
rare ; but they might be accepted as probable where no signs 
of violence or soreness of the parts existed. The muco- 
purulent discharge which invariably follows upon the de- 
floration of a young girl should not be confounded either 
with gonorrhea or with infantile leucorrhea. The latter 



280 MEDICAL JURISPRUDENCE. 

disorder is of spontaneous origin, and is very common among 
children of the lowest orders whose hygienic surroundings 
are bad. The existence of this discharge is not infrequently 
rriade the ground of complaint against an innocent man for 
a felonious assault upon the person of the young girl, who 
has been previously tutored to tell her story, even to its 
minutest details. In cases of this kind it is always best to 
examine the child apart from all her associates, but in the 
presence of a competent third party if possible. 

Gangrenous inflammation of the vulva is more rare than 
infantile leucorrhea ; it sometimes prevails epidemically, and 
occurs as a sequel to low fevers and other prostrating dis- 
eases ; it is found almost exclusively among neglected, filthy 
children, suffering from exhaustion and want of food. The 
mortification in these cases frequently terminates fatally. 

To diagnosticate properly between these spontaneous in- 
fantile diseases and gonorrhea or a muco-purulent discharge, 
the examiner should remember that a true gonorrheal dis- 
charge does not come on until about the fourth to the eighth 
day, and is usually very profuse — much more so than that 
which results simply from the violence of defloration ; also, 
that its duration is much longer. Casper recommends that 
in doubtful cases a second examination should be made in 
the course of a week or ten days. If the purulent discharge 
has then ceased, or is about ceasing, there is good reason 
to believe that it was not due to gonorrhea. Again, if the 
muco-purulent flow is of spontaneous origin (leucorrhea), 
there will be an absence of blood ; whereas, if it be due to 
violence (rape), there will always be more or less effusion 
of blood, along with dilatation, and probably laceration of 
the vagina and rupture of the perineum. The discovery of 
the specific microbe will aid materially in this examination. 



RAPE. 281 

In all such cases the person of the accused should be cx- 
ammed for evidences of gonorrhea, and also for blood stains 
upon his person or clothes ; but the absence of the latter 
would be no proof that he had not committed the crime, 
since the bleeding of the pudendum may not have taken 
place until after the act. Several cases of this character have 
been reported. Moreover, the discovery of seminal stains 
upon either the accused or the victim might be regarded 
as positive proof of guilt, unless it could be shown that a 
previous and recent defloration has occurred. 

Rape on young children has not infrequently resulted in 
death; the violent laceration of the vagina and perineum 
producing, in some instances, mortification, and in others 
fatal peritonitis. 

Rape on Adult Females. — The question is frequently 
raised as to the possibility of a rape being committed by 
one man upon a healthy, vigorous, adult woman. A deter- 
mined and vigorous resistance may prevent the perpetration 
of the crime. On the other hand, the woman may be forced 
to yield through fear of her life, or duress, or may be 
actually overpowered through superior strength, or fraudu- 
lently deceived by the administration of narcotics or anes- 
thetics. Every case must be judged on its own merits. 
The physician has simply to state, from an examination of 
the parties, that sexual intercourse has taken place, leaving 
the jury to decide whether or not rape has been perpe- 
trated. Doubtless, in some of the many false accusations 
of rape, Sancho Panza's mode of sifting the evidence and 
his subsequent judgment in the case, during his brief though 
brilliant experience as Governor of Barataria, might be held 
up as a safe guide to follow. In some cases there are accom- 

25 



282 MEDICAL JURISPRUDENCE. 

plices to the crime, when, of course, there can be nO' hesita- 
tion as to the possibility of overcoming the resistance of the 
victim by mere brute force. 

It must also be admitted that rape may be perpetrated on 
adult women when rendered unconscious by means of power- 
ful narcotics or anesthetics, or when thrown into the mes- 
meric condition, or when in syncope or the coma of apo- 
plexy; but whether the act can be accomplished when the 
female is merely in a profound natural sleep, and uncon- 
sciously to herself, is a question which admits of consider- 
able discussion. The cases of this character are certainly 
exceptional ; but their possibility must be admitted — cer- 
tainly in the case of women accustomed to sexual inter- 
course, but very doubtful in the case of virgins ; although 
we may not deny the possibility even in the latter, inas- 
much . as authentic instances are mentioned by reliable 
authors. There will always necessarily be more or less 
doubt in the matter, and the oft-quoted dictum of Valentin 
deserves consideration: '' non omnes dormiunt quae clausos 
habent oculos." 

A question of much importance is whether the anesthetic 
effects of ether or chloroform are capable of so completely 
abolishing consciousness and sensibility on the part of a 
woman, especially a virgin, as to permit the successful per- 
petration of a rape. A somewhat remarkable case involv- 
ing this question was tried in Philadelphia in 1854. The 
plaintiff was a young lady of unimpeachable character, who 
charged a respectable dentist with committing a rape 
upon her while in his office and under the anesthetic influ- 
ence of ether for the purpose of an operation upon her teeth. 
She averred very positively in her testimony that she was 
conscious of his *' entering her person," and then " felt pain," 



RAPE. 283 

but she '' was not able to cry out or resist," and " all this 
time was conscious of everything that was going on." She 
afterward " opened her eyes," and again " closed them im- 
mediately." After this alleged liberty she states that she 
inhaled the ether a second time, at the doctor's request, in 
order to have a tooth extracted. When this was over she 
made a second appointment with him for some days after. 
She parted with the dentist at his front door without making 
complaint, leaving a kindly message for a mutual acquaih- 
tance. From his office she walked a considerable dis- 
tance to a friend's house, stopping on the way at a con- 
fectioner's to partake of ice cream. After a visit to a 
friend she again walked quite a distance to another friend's 
house, where she remained several hours, and after tea 
on that same evening first informed any one of the alleged 
outrage ; and on the same afternoon her catamenia ap- 
peared, which was her regular time. She further stated 
that " she did not examine her person before the appearance 
of the menses, nor did anybody examine her garments be- 
fore two days had elapsed. She was never examined by any 
physician." Her complaint was lodged before the authori- 
ties, and the defendant was arrested, tried, convicted, and 
imprisoned for a term of years. 

The general opinion of the medical and legal professions, 
both at the time of this trial and since, was that this convic- 
tion was unjust, and unwarranted by the circumstances of 
the case. The most serious defect in the evidence was the 
total absence of any medical examination to prove the recent 
defloration of the plaintiff. It really appears to us unac- 
countable how such a grave charge could have been for a 
moment entertained by the court and jury against a man of 
unsullied character in the absence of this most important 



284 MEDICAL JURISPRUDENCE. 

link in the chain of evidence. We must suppose it to have 
been one of those instances mentioned by Sir Matthew Hale, 
" wherein the court and jury may, with so much ease, be 
imposed upon without great care and vigilance, the heinous- 
ness of the offense many times transporting the judge and 
jury with so much indignation that they are over-hastily 
carried on to the conviction of the persons accused thereof, 
by the confident testimony of sometimes false and malicious 
witnesses." The defendant practised dentistry for many 
years in reputable professional standing. 

The important point in the above and similar cases is 
whether an individual under the influence of anesthesia 
has such complete control over the mental faculties as to 
fully recognize and appreciate what is transpiring around 
her, and afterward to minutely describe all the particulars, 
and yet, at the same time, lose the power of resistance ? Such 
an abolition of the will as to destroy all power of resistance 
implies a narcotism so complete as to produce complete un- 
consciousness. Nothing is more certain than that in such a 
person the sense of external impressions becomes at first 
very confused, and very soon is entirely obliterated. The 
most painful operations seem to produce no sensation what- 
ever. As to the perceptions, they soon become perverted; 
the person passes rapidly into dreamland, " the inward per- 
ceptions of the mind being sometimes of the most agreeable, 
and at others of the most painful character ; and these dreams 
may or may not be pertinent to the actual position of the 
patient." 

But it is especially upon the emotions that the effects of 
etherization are most conspicuous ; some exhibit signs of 
irrepressible mirth, while others appear weighed down by 
despondency or excited to violent anger. Women are espe- 



RAPE. 285 

cially liable to be thus afifected, and in some the erotic feel- 
ings are unquestionably excited to a high degree. We have 
frequently witnessed this ourselves in female patients, and 
the fact is abundantly corroborated by others. The case 
just alluded to was of a character precisely suited to illus- 
trate this point. The young lady was betrothed in marriage ; 
she was accompanied by her lover in her walk to the den- 
tist's ; she was just at her menstrual period. What more 
natural, under such circumstances, and when her senses were 
'' stolen away " by the anesthetic, than that her dreams or 
false perceptions should take the direction which should give 
rise to erotic emotions and sensations ? That this is not mere 
speculation is shown by well-attested facts. M. Dubois re- 
lates a case under his own observation where a woman 
undergoing an operation, under the influence of ether, drew 
an attendant toward her to kiss him as she was lapsing into 
insensibility ; and she afterward confessed to dreaming of 
coitus with her husband while she lay etherized. Another 
case closely resembling the one now under consideration 
occurred in IMontreal in 1858. A dentist was indicted for 
attempting to commit a rape upon one of his patients under 
the influence of chloroform. At the trial a witness testified 
that his wife was under the strongest impressions that she 
had been violated while under the influence of chloroform ; 
yet the husband had been present during the whole time. 

In such cases, therefore, extreme caution should be exer- 
cised in receiving the testimony of a prosecutrix who was 
under anesthetic influence, unless her statement is corrobo- 
rated by a proper medical examination. 

Medical Evidences of Rape on Adults. — In the majority 
of these cases the examination is postponed so long as to 



286 MEDICAL JURISPRUDENCE. 

afford very few satisfactory data to the physician, since all 
traces of violence in adults may disappear in a few days. 
If much resistance has been offered there will generally be 
found bruises upon the thighs and legs, and possibly upon 
the arms and trunk, and even on the neck, when an attempt 
at partial strangulation has been made ; but these are incon- 
clusive of rape without the presence of marks of violence 
upon the pudendum. Besides, they may be produced by 
the woman herself, in order to substantiate a false accusa- 
tion. In children, for obvious reasons, these marks of 
violence do not occur. The truly important medical signs 
are derived from the condition of the hymen and of the 
sexual organs, and from the presence of seminal and blood 
stains. It should be remembered that these physical marks 
of rape about the genital organs may be found whether the 
connection has been voluntary or involun,tary. 

Thus, rupture of the hymen, laceration of the vagina, 
swelling and soreness of the organs, effusion and coagula 
of blood, stains of semen and blood upon the person and 
clothing, may be met with in both cases. 

Another circumstance to be recollected is that girls and 
young women are liable to a muco-purulent discharge aris- 
ing fromi vaginitis, somewhat similar to that already noticed 
as found in young children under bad hygienic conditions. 
Older women are liable to leucorrhea, which may some- 
times be accompanied with an ulcerated state of the vagina 
and general soreness and swelling of the parts. It is pos- 
sible that a woman thus affected might bring a false charge 
of rape against an innocent man, alleging that her present 
condition was the result of a rape. Although an ordinary 
leucorrhea can readily be distinguished from a gonorrhea, 
- — the discharge of the latter being purulent, while it is 



RAPE. 287 

mucous in the former, — yet a purulent discharge may take 
place from the vagina, as the result of an intense vaginitis, 
quite independently of sexual intercourse ; and such a dis- 
charge cannot readily be distinguished from that of gonor- 
rhea. Taylor very properly remarks that '' such discharges, 
commencing before but continuing and sometimes becom- 
ing aggravated after marriage, have given rise to unfounded 
suspicions of infection from venereal disease imparted by 
the husband, and have thus led to suits for divorce." 

Condition of the Hymen — Virginity. — Much has been 
said about the unruptured condition of the hymen being 
accepted as a proof of chastity or of virginity, and unques- 
tionably in the great majority of cases this is true ; but it 
cannot be affirmed absolutely and without exception, inas- 
much as authentic instances are recorded where the hymen 
has been destroyed, either by accident, disease, self-abuse, 
or by a surgical operation to allow the escape of the menses ; 
and, on the other hand, where sexual intercourse has been 
continued for years with the hymen unruptured, and where 
even pregnancy had resulted, and it became necessary to 
divide the membrane with a knife before delivery could be 
accomplished. 

In the exceptional cases just alluded to, of the persis- 
tence of the hymen after repeated intercourse, this anomaly 
may be ascribed, according to high authorities, to an abnor- 
mally firm, hard, and, resisting structure of the membrane, 
due to the presence of a fibrous or fibro-elastic tissue. It 
therefore must follow, from all the above facts, that the loss 
of the hymen is not an infallible proof of a loss of chastity ; 
nor does the existence of a hymen constitute an absolute 
evidence of its presence. Casper, however, considers '' that 
where a physician finds a hymen still preserved, even its 



288 MEDICAL JURISPRUDENCE. 

edges not being torn, and along with it (in young persons) 
a virgin condition of the breasts and external genitals, he is 
then justified in giving a positive opinion as to the existence 
of virginity, and vice versa/' 

The other external evidences connected with the sexual 
organs, such as swelling and soreness of the vulva, the 
presence of effused blood and of seminal stains, would all 
afford strong corroborative proof of rape, provided want of 
consent could be satisfactorily shown and an early exami- 
nation be made. 

Blood and Seminal Stains. — These may be found upon 
the persons and clothing of both the ravisher and his victim. 
If the garments are tolerably clean, there should be no diffi- 
culty in recognizing these spots ; but they are frequently 
presented for examination in such a filthy condition as to 
render their identification very difficult. Moreover, a mis- 
take may arise from the woman's garments being intention- 
ally soiled with blood, in cases of false accusation. 

The manner of examining blood stains has already been 
explained. 

Examination of Seminal Spots. — These stains cause a 
stiffening of the fabric, like those produced by albumin or 
gum. The seminal stain may be identified as follows : If 
gently warmed, it will assume a pale yellow color. If 
moistened with warm water, it will emit the seminal odor. 
Cut out the suspected stain and place it in a watch glass, 
adding a few drops of pure water and gently squeezing it 
with a glass rod until thoroughly soaked; remove the frag- 
ment and add a drop of nitric acid on a glass rod, when 
the liquid, if seminal, will turn a yellow color, without giv- 
ing a precipitate. The best results will be obtained by 
placing a small fragment of the stained material on an 



RAPE. 289 

ordinary microscopic slide, moistening it with a drop of dis- 
tilled water, and placing over it a cover-glass. After soak- 
ing for a short time (30 to 60 min.) the cover-glass is 
rocked by pressing on alternate sides, thus causing a cur- 
rent of water to flow through the fabric, from which the 
spermatozoids will gradually float out. Several slides should 
be prepared from each stain. If very good results follow 
the application, the cover-glass and fabric may be removed 
and the slide dried and preserved ; under ordinary circum- 
stances such results are not attainable. If the water used 
in the test be slightly tinted by eosin or methyl blue, the 
spermatozoids will take up the dye, and may be more easily 
detected. Cut out a fragment containing the stain and treat 
it with distilled water as above described. After sufficient 
soaking, apply a drop of the liquid to a glass slide and place 
it under the microscope, using a very high power. 

The spermatozoids have a characteristic appearance. 
They vary considerably both in numbers and size. On an 
average, the human spermatozoid is about the q}-^ of an 
inch in length, having a flattened, ovoid head, which is 
about one third the diameter of a human blood corpuscle. 
Attached to this head is a thread-like, tapering tail, that is 
eight to ten times longer than the head. Very often, in 
old seminal stains the spermatozoids will be found only in 
a fragmentary state, and the examiner should be cautioned 
not to confound these with fibrillae and other bodies which 
might be accidentally present. The absence of spermato- 
zoids is not to be regarded as conclusive that the spot is 
not seminal, since, as Casper and others have shown, the 
seminal fluid does not always contain them ; they may be 
absent in certain debilitating diseases, after excessive venery, 
and in very aged men. 
26 



290 MEDICAL JURISPRUDENCE. 

These bodies exist in the semen of all animals capable of 
procreation, and they are found in man from the age of 
puberty to a very advanced period of Hfe. 

It is possible to mistake fragments of the spermatozoids 
for fibrils of linen and other fabrics washed out at the time 
of the examination. A proper degree of caution, together 
with a knowledge of the peculiar microscopic appearance of 
these fibrils, should prevent this mistake. Hence, in such 
an investigation it is safest not to decide upon the seminal 
character of the stain unless one or more complete sper- 
matozoids are found. 

M. Donne has described an organism called by him 
Trichomonas vagince. It is found in vaginal mucus, and 
resembles the spermatozoids, but differs in having the head 
three times as large ; it is also granular, and armed with a 
row of four or six cilia. 

The spermatozoids appear to retain life long after the 
death of the body. Hoffmann observed active movements in 
them from eighty to one hundred hours after death. In the 
dried state they may be identified years afterward. 

In some cases of alleged rape it may be necessary to 
examine the vaginal secretion for evidence of recent inter- 
course. If this has occurred, the presence of the sper- 
matozoa may easily be discovered by placing a drop of the 
mucus upon a glass slide and subjecting it to microscopic 
examination. It has been shown by Miiller that the sper- 
matozoids will retain life and activity for eight days in the 
vaginal mucus. 

Florence's Test for Semen. — This depends on a reaction 
with the transformation products of lecithin, and may, 
therefore, give results with other materials than semen, such 
as nerve tissue and some vegetable structures, that contain 



RAPE. 291 

lecithin, but with care the test is useful and has been found 
valuable as a confirmation. A test solution is prepared as 
follows : 

Potassium iodid 1.650 grams. 

lodin 2.540 

Water 3000 

A small portion of the suspected stain is placed on a 
microscope slide, moistened with a little water, allowed to 
soak for a few minutes and then a drop of the reagent is placed 
so that it will spread into the liquid. A cover-glass is then 
put on and the slide examined under moderate power. 
Crystals like those of hemin (see under blood-tests) are 
produced with semen. 

Post-mortem Evidence of Rape. — The physician is some- 
times required to determine the fact of violation previous to 
death when a murder has been committed. The difficulty 
here is, of course, increased by the absence of evidence from 
the woman. The proofs of violation in the case of a very 
young girt would be easily made out ; but in the case of an 
adult, even if the evidence of rupture of the hymen and 
vulval swelling and effused blood pointed to a recent deflora- 
tion, this would not prove the want of consent on her part. 
If, however, there existed at the same time other marks of 
extreme violence upon the body, this would be strong cir- 
cumstantial evidence that the outrage had been perpetrated 
before the murder. 

Cases of sexual intercourse with the dead body have 
occurred at all periods of human history. Of late years 
several cases have been detected among morgue keepers. 
Obviously, there will be difficulty and uncertainty in fasten- 
ing the offense on any one, unless, as has occasionally 
happened, the person is caught in the act. 



292 MEDICAL JURISPRUDENCE. 

Rape of Females on Males. — This crime is rarely brought 
before the courts, but seems to be more common than has 
generally been supposed. Boys are occasionally induced 
or forced into sexual intercourse with adult women to 
gratify the erotic feelings of the latter without the danger 
of pregnancy. A boy seven years old, with well-marked 
gonorrhea, presented himself for treatment at the clinic of 
the Jefferson Medical College Hospital. He stated that he 
had contracted the disease by gratifying the erotic desires 
of a married woman whose husband was at sea. 

Unnatural Crimes. — Sodomy — Pederastia ; Bestiality. — 
Sodomy, or Pederastia, is the unnatural intercourse of man 
with man. Bestiality implies imnatural intercourse with 
animals. Both acts are criminal, and are regarded by the 
law as felonious, and are punished in England by penal 
servitude and in this country by imprisonment for a term 
of years. 

In the case of sodomy, both the parties are held to be 
equally guilty, unless it can be shown that one was not 
consenting, was under age, was unconscious at the time, or 
was idiotic or insane. The facts of this crime are usually 
proved without medical evidence, except in the case of 
young persons, when marks of physical violence will usu- 
ally be sufficiently apparent. Collateral proof would be 
given by the discovery of seminal stains upon the person 
or linen. 

Unless the examination be made soon after the perpetra- 
tion of the act, all evidence of it will have disappeared, just 
as in cases of rape. In those habituated to this vice, there 
are, according to Casper and Tardieu, certain alterations of 
the parts that may be regarded as characteristic, such as a 



RAPE. 293 

funnel-shaped condition of the anus, which is enlarged, 
smooth, and even patulous, the folds, or vugx, having dis- 
appeared. There may also be other marks around the 
anus, such as cicatrices, chancres, and venereal warts. In 
recent cases, laceration of the sphincter ani, fissures, and 
bruises, with efifusion of blood, might all be observed. 

Legal Relations of Rape. — The crime is not excused if 
the woman has submitted — 

(i) From stupefaction, produced either by disease (coma) 
or by drugs — including alcohol, chloroform, and ether — 
or by hypnotism. Although, in such cases, the violation, 
strictly speaking, be not against her will, it is without her 
will, which is regarded as the same thing. This is true, 
even if it can be shown that the drug was administered for 
the purpose merely of exciting, and not stupefying. It 
is vastly important that the distinction should be clearly 
drawn between the erotic sensations and perverted impres- 
sions of a female while under an anesthetic influence for 
surgical operations, and who may subsequently institute a 
false accusation, and similar sensations resulting from the 
criminal administration of chloroform or ether for this very 
intent, and where the will or resisting power appears to be 
taken away before the anesthesia is complete. 

(2) From Ignorance of the Nature of the Act. — Such 
instances occur in young children, and in older women who 
are idiotic or insane. In some recent cases, both in this 
country and in England, it has been held that, in dementia 
not amounting to positive idiocy, if consent were given, and 
no compulsory force employed, it does not constitute rape. 

(3) From Mistake of Person. — More than one case has 
been reported in which a married woman was raped in her 
sleep, supposing she was embraced by her husband. 



294 MEDICAL JURISPRUDENCE. 

(4) From Fear. — Submission extorted through fear of 
death or violent threatening is no excuse for the act. 

(5) From Prior Want of Character of the Prosecutrix. — 
Prior want of character in the woman is no ground of excuse 
for the crime, if it was perpetrated by force and against 
her will ; not even if she were a common prostitute or the 
mistress of the defendant. The allegation of unchastity in 
the woman could further be supported by a medical exami- 
nation, which might reveal the existence of syphilis or 
gonorrhea. This examination is not compulsory; the 
woman is not obliged to convict- herself. 

(6) Subsequent Suppression of the Fact by the Prosecu- 
trix. — If the alleged violation be suppressed by the women 
for such a time as to prevent any evidence being obtained 
by a medical examination, this will go very far in lessening 
the credibility of her testimony. Not a few instances of this 
character have turned out to be cases of false accusation. 

(7) Want of Age and of Sexual Capacity of the Defend- 
ant. — According to the law, a child under a certain age is 
presumed to be incapable of committing a rape, though he 
may be convicted of an assault with intent to ravish. The 
want of sexual capacity is purely a medical question to be 
determined at the time. 



CHAPTER XIII. 
INSANITY. 

In a work like the present, it would be impossible to enter 
into an extended discussion of this subject. Reference must 
be made to the many admirable treatises now accessible, both 
in English and foreign languages. All that can be accom- 
plished is to present the subject under particular phases, 
with a special reference to its medico-legal relations, so as 
to enable the student to understand the proper professional 
position in reference to that class of persons who have been 
deprived of reason — how to determine, first of all, the fact 
of their insanity, and, secondly, its character, as involving 
the all-important question of their civil and criminal respon- 
sibility. 

The physician may encounter considerable difficulties in 
distinguishing between cases of real and alleged insanity. 
In the first place, there is the difficulty, if not the actual im- 
possibility, of determining the precise boundary between 
normal and abnormal mental action, just as it is often im- 
possible to do in the case of other diseases. Even in respect 
to the individual mental powers or faculties, much difference 
is observed. Rarely do we find entirely normal and har- 
monious adjustment of all the powers of the mind. Scarcely 
ever is a person discovered in whom no one of the mental 
faculties is allowed to exert an undue preponderance. " On 
the one hand, for instance, individuals are observed who 
possess, along with a wondrous power of memory, just as 
feeble a power of judgment ; while others to the most vivid 

295 



296 MEDICAL JURISPRUDENCE. 

powers of imagination conjoin a most wretchedly deficient 
power of will. In one, an excessive vivacity of character 
may betray its possessor into actions which may raise doubts 
as to his actual sanity; whilst in another, originality of 
character, flashing out as true genius, may so stamp its pecu- 
liarities on every act as to require a sharp observation if the 
limits of sanity have not been over-stepped." (Casper.) 

Another great difficulty in deciding this matter arises 
from the impossibility, often, of discovering the motives of 
any action, even the most extraordinary. Whilst the ab- 
sence of all rational motive may usually be regarded as 
indicative of an insane act, we must not be too ready to 
admit this absence in any particular case, since these motives, 
as Casper justly remarks, " may be so deeply buried in the 
soul of the agent as frequently to baffle the greatest experi- 
ence in arriving at a logical conclusion." The subject of 
motive in the acts of the insane will be noticed further on. 

Still another difficulty in the diagnosis of an alleged 
mental disorder is presented by the possibility, on the one 
hand, of its being feigned, and, on the other, of the real 
disease being concealed by the subject with the most con- 
summate art. 

All the medico-legal questions arising out of insanity are 
comprehended under inquiry as to the civil and criminal 
responsibility of the individual. 

Civil responsibility means the capability of managing the 
ordinary affairs of civil life, such as the entering into con- 
tracts, the making of a will, the performing the functions of 
a public officer, or, in common-law phrase, '' the managing 
his own affairs." *" 

Criminal responsibility has reference solely to criminal 
acts, and involves the inquiry whether an individual commit- 



INSANITY. 297 

ting some particular crime, such as murder, theft, or arson, 
was in such a state of mind at the time of the commission 
of the deed as to constitute him a responsible agent? 

One other point is to be noted : every human being of 
responsible age and sound mind is regarded as possessing 
will power, moral freedom of choosing between good and 
evil. Although, in consequence of faulty training, bad asso- 
ciations, and temptation, one may " choose the evil," yet 
everyone is fully responsible for such choice and for all its 
consequences, when he possessed at the time a sound mind. 

Legal Terms. — Before further entering upon a discus- 
sion of the subject, it will be proper to define certain legal 
terms. A medical witness should confine his answers 
strictly to the questions put to him, and speak of insanity 
only as a disease, avoiding the tendency to theorize, or 
speculate upon legal distinctions. 

An illusion is a false mental impression derived through 
the senses. Real things are distorted. A timid person, for 
instance, mistakes in the dark a post or a shrub for a man ; 
the drapery of a bed, in the moon-light, is distorted into an 
apprehended ghost. Sometimes the false impression is en- 
tirely mental, reproduced by the memory, or by a strong 
eflfort of the will, recalling the scenes of past pleasures or 
sorrows, the features and persons of friends, and even the 
tones of their voices and other sounds. Such mental images, 
denominated by Rush waking dreams, are called spectral 
illusions, or phantasms, when they have reference to the sense 
of sight, although the actual vision of the individual may, at 
the time, be defective, since they occur equally to the blind. 

The distinctive characteristic of an illusion is that the 
false perception can be soon corrected by an appeal to the 



298 MEDICAL JURISPRUDENCE. 

Other senses or to the judgment. If, however, it is persist- 
ently believed to have a positive existence, and this belief 
is not removed either by reflection or by a reference to the 
other senses, then the illusion becomes a delusion, or a mis- 
leading of the mind, and the phenomenon indicates a dis- 
ordered mind. 

A hallucination is also a perverted perception, but with- 
out material basis. The false impressions are often con- 
veyed through the organs of hearing. If the individual is 
able to correct them by his judgment, or by reference to 
his other senses, they are of no significance ; but if they 
are firmly believed in, they indicate a deranged mental con- 
dition. For a person to fancy that he hears strange voices, 
constantly urging him on to the commission of crime, to see 
imaginary personages, or to believe that a thunderclap is a 
voice from God, is among the surest indications of insanity. 

Some writers make no distinction between hallucinations 
and illusions, whilst others, regard them as differing in 
this : a hallucination is an unreal sensation wholly due to 
the action of the brain ; an illusion is a real sensation — that is, 
is produced by some real object, although distorted. Nicolai, 
the Berlin bookseller, was for years troubled with seeing 
unreal objects (spectral illusions), and sometimes by hear- 
ing unreal sounds (hallucinations), but he did not beHeve 
in them ; hence they never became delusions in his case. 

A delusion is a belief in something that has no real ex- 
istence, and in which the belief cannot be corrected by the 
judgment, nor when confronted with contradictory proof, as, 
e. g., when a man imagines himself made of glass, and is 
afraid to suffer any one to approach him, lest he be broken 
to pieces; or where a pauper fancies himself to have sud- 
denly become a millionaire or a king; or where a rich man 



INSANITY. 299 

imagines himself to have been reduced to beggary. All such 
delusions are clear manifestations of mental disturbance. In 
legal matters, however, the question of responsibility 
(whether civil or criminal) depends upon the connection of 
the act with the particular delusion. For example, if the 
delusion is such as to prevent the individual from exerting 
a " rational act of volition " in the matter of disposing of 
his property by will — as when, through such delusion, the 
result of disease, he may have come to entertain a bitter 
hatred for those entitled to his love and gratitude — then he 
does not possess testamentary capacity, and is, so far, of 
unsound mind. But if the delusion be upon a subject en- 
tirely disconnected with the act, as where, for example, it 
has reference to his religious state, then the responsibility of 
the individual is not necessarily destroyed, and his testamen- 
tary capacity should be regarded as unaffected. 

The existence of the most extraordinary delusions for 
years, in an individual, is quite consistent with an otherwise 
apparently sound mental condition. Dr. Reese was ap- 
pointed with a highly-educated lady, an artist of consider- 
able abilities, who entertained the delusion that she was, in 
some mysterious manner, incorporated with the Holy 
Trinity, and that she received direct communications from 
the Father, which required her to give up all her church 
relations and her former very strict orthodox creed. Yet 
this lady went out into society, conversed intelligently upon 
ordinary subjects, and passed generally for a sensible 
woman. 

The cunning of the insane in concealing their delusions 
is often quite remarkable. Every superintendent of an 
asylum has had experience of it in patients under his obser- 
vation. Perhaps the best illustrations are afforded in cases 



300 MEDICAL JURISPRUDENCE. 

in which patients, who wish to escape from an asylum, are 
brought into court, under writ of habeas corpus, for their 
discharge, and where they so skillfully and adroitly pass 
their examination as often to deceive both court and jury. 

The coincidence of insanity with high intellectual ability 
is frequently observed in civilized life. Recently, a case has 
been reported in detail in which a professional politician, an 
able lawyer in a western state, was more than once com- 
mitted to an asylum for the insane, and succeeded in securing 
release by arguing his own case. He exhibited typically the 
condition known as circular insanity, in which periods of 
exaltation, more or less violent, are broken by conditions of 
depression or by apparently normal states. Placed in an 
asylum during one of the more violent periods, he secured 
a hearing by writ issued at his instance, argued his own case 
with much dialectic skill, but with such unrestrained temper 
that he was fined for contempt because, in open court, he 
called the trial judge a '' cheap skate." He was adjudged 
sane by a jury, but immediately on his return to his home 
passed into a depressed condition and for some days ex- 
hibited great fear whenever any one asked to see him. Had 
the depression period occurred before the close of the trial 
the verdict would probably have been different. 

The border line between sanity and insanity is shifted by 
scientific progress, by which doctrines and capabilities are 
seen under new lights. Thus, the eminent English lawyer, 
Sergeant Ballantyne defended a woman whose relatives de- 
sired to take from her the control of her estate on the ground 
of mental unsoundness. Her delusion was that she had been 
divinely designated to receive the Messiah on His second 
advent. This doctrine, which most people now regard as 
unworthy of consideration, was held firmly by many of the 



INSANITY. 301 

Christians of the first century, and was treated by some of 
the Fathers as entitled to every consideration. Some years 
ago, a member of the Philadelphia bar was made the subject 
of legal proceedings to restrain control of his property, be- 
cause he believed that persons were trying to fill him with 
electricity by means of invisible wires. At that time the 
transmission of an electric charge over a distance of more 
than a few inches without a conductor was not possible, but 
it is now possible to do this over hundreds of miles. The 
absurdity of this attorney's delusion is, therefore, much less 
apparent than formerly. 

The progress of knowledge also adds to the varieties of 
delusions. In one recent case, the earliest decided manifes- 
tations of delusional insanity was an order by a very wealthy 
man for one thousand automobiles. It is obvious that, while 
on order for several automobiles might have been equally 
due to the influence of a delusion, yet in view of the wealth 
of the person it would have been regarded as extravagance, 
but not in any way evidence of unsound mind. The excessive 
amount can, of course, be explained on only one assumption, 
that of insanity. 

A positive and unobjectionable definition of insanity can- 
not be obtained. Each alienist will tend to define and classify 
according to his own methods. Persons not expert in the 
subject have some general ideas which lead to confusion and 
often to injustice. Idiocy and imbecility are classified by 
alienists as forms of insanity, yet it is probable that many 
persons, even attorneys and judges, would hesitate to accept 
this inclusion. In a case which attracted considerable atten- 
tion about twenty years ago in Philadelphia, in which the 
heirs of a medical man tried to prove his lack of capacity, the 
following habits were alleged as evidences of unsound mind : 



302 MEDICAL JURISPRUDENCE. 

That he was shabby and dirty ; wore old clothes ; an old 
battered high hat ; a bandanna handkerchief for neck cloth ; 
wiped his hands on his coat after cleaning fish and chickens ; 
had his clothes selected for him by his sisters ; talked in a 
rambling fashion ; laughed in monosyllables ; mumbled to 
himself ; said " Yes, yes, yes ; no, no, no " when questions 
were asked ; was nervous and unable to sit still ; picked up 
things and put them down ; ran in and out of the room ; got 
furiously angry and chattered with rage ; looked wild and 
fierce ; preached in the garden and on the front steps ; went 
into the street oddly or partially dressed ; marched with the 
Salvation army; played hide and whoop with his wife in a 
rough and tumble manner ; refused to keep servants ; cooked 
his own food and let his wife do the washing when she was 
sick ; when his sister died, he said, " Liz is dead, hurrah, now 
I am a free man " ; threw his hat at roosters when they 
crowed ; chased a cat and threatened to kill it ; chased a boy 
who called him '' crazy old doctor " ; behaved strangely at 
church while hymns were sung. 

It is obvious that of this long list, very few items are 
worth anything as evidence of mental unsoundness. Most 
of them owe their slight apparent eccentricity to the discon- 
nected recital. To chase a street Arab who is calling one 
names and to talk to one's self are entirely normal actions 
under ordinary conditions. For a resident of the city to 
throw some light object, such as a hat, at a crowing rooster 
that is annoying him at 4 a. m. is not in any way astonishing. 

In the same case, a magistrate testified that he regarded 
the person in question not as an idiot or insane man but as 
lunatic or crazy man ! On being pressed to give his distinc- 
tions of these terms, he said " The insane man is not capable 
of taking care of himself at all, and has to be confined. The 



INSANITY. 303 

idiot has no mind at all, a mere child in point of intellect. A 
lunatic is not capable of forming a judgment or has no judg- 
ment, and might be influenced to his own injury ; a lunatic 
is a crazy man to some extent." 

The following description is copied from J. Dixon Mann's 
work on Forensic Medicine and Toxicology. It is inserted 
because it is a vivid and typical picture of the course of a 
case of simple insanity : 

" Insanity does not develop in a moment ; there is a period 
of ingravescence during which the individual affected grad- 
ually deviates from his ordinary mental condition. Although 
the symptoms evinced during the various stages of insanity 
are irregular and do not follow any definite order, certain 
of them are of common occurrence, some of which are 
present in every case; a knowledge of these symptoms is 
essential to an early recognition of mental disease. The 
onset of insanity may be so insidious that long before any 
distinctive indications are manifest an alteration in tempera- 
ment is noticeable ; the individual is different from what he 
was formerly ; he has lost his equanimity. When insanity 
begins in this insidious way the emotions are affected long 
before the mind is impaired. The patient is subject to un- 
accountable waves of depression, which may alternate with 
periods of excitement ; he becomes unwontedly irritable 
and is unable to control his temper under the petty annoy- 
ances of every-day life. This instability of temper may be 
the condition that first arouses suspicion in the minds of his 
friends that insanity is the cause of the change in dispo- 
sition. A man who has been moody and reserved in his 
manner for some time is credited with being overtaxed with 
business, and is thought to be a little out of sorts, but noth- 
ing more ; at some trifling contradiction or annoyance he 



304 MEDICAL JURISPRUDENCE. 

suddenly blazes up into a frenzy of passion, and behaves 
for the moment so like a madman that the bystanders are 
at once impressed with the idea that the balance of his 
mind is impaired. A change in the emotions is also com- 
monly shown by transformation of like into dislike, or love 
into hate. A man shows unwonted impatience at the re- 
marks addressed to him by his wife, whose opinion he 
previously valued, and then manifests an absolute antipathy 
to her, a sentiment totally at variance with their former 
relations. Loss of interest in objects and pursuits which 
formerly occupied his attention, desire for solitude perhaps 
at first shown by avoidance of social intercourse in a general 
way, and then, in a more special manner, by seclusion from 
the family circle, are further evidences of perverted senti- 
ments. At this period, the person affected is often quite 
capable of brightening up in the presence of strangers, or 
of friends for whom he has a special liking; he will even 
remark that he feels better in company — meaning in the 
society of those with whom he is not necessarily brought 
into relation. 

" So far the intellect is unimpaired. The capacity to fulfill 
the duties which devolve upon a merchant or professional 
man may be equal to the requirements ; but the work is 
done in a perfunctory way without the display of any inter- 
est. The morbid state of the emotions, however, soon 
reacts on the mind in such a way that the reasoning proc- 
esses are interfered with, and the judgment is no longer 
that of a sane person : emotional depression gives place to 
morbid apprehensions, and an indefinite feeling of melan- 
choly to dread of impending ruin in this world or in the 
future state. Delusions occur at this stage. Among the 
commoner delusions in the early stages of insanity is the 



INSANITY. 305 

conviction that some one — generally a member of the pa- 
tient's family — has commissioned the police or a private 
individual to act as a spy on the person laboring under the 
delusion ; that there is a conspiracy to ruin him, or to deprive 
him of his rights ; that attempts are being made to poison 
him. 

Lucid Interval. — This term, much used in legal investiga- 
tions of the insane, cannot be regarded as of scientific value 
under existing definitions. The history and alleged meaning 
of the phrase have been thoroughly and ably discussed by 
Lloyd (Wharton & Stille, Medical Jurisprudence, 5th edi- 
tion, Vol. 3) who shows that it arises from the old view 
that lunacy was dependent on the changes of the moon. 
Much quibbling has been developed among lawyers in rela- 
tion to the term. All diseases are liable to changes in 
intensity, either apparent or real. It is often impossible to 
determine if the abatement of a particular symptom is due 
to the decrease of the pathologic condition on which the 
symptom depends, or to the lowered ability of the organs to 
react to the abnormal influences. Thus, the spasms of 
strychnin poisoning are interrupted not because the poison 
is losing its power but because of the temporary exhaustion 
of the muscles. So, in insanity, many conditions tend to 
modify the manifestations. The intense pre-occupation of 
the mind may for a time suspend the symptoms of unsound- 
ness. It can easily be conceived that in a delusional maniac 
who had suffered a painful injury, such as burning or crush- 
ing, or who found himself in imminent bodily peril in a 
railroad or steamship disaster the delusions might play for 
the time being secondary part. 

The legal theory of lucid interval seems to be that of more 
than mere remission of symptoms. It is an actual suspension 
27 



306 MEDICAL JURISPRUDENCE. 

of the insane state. Several leading alienists have expressed 
their disbelief in the value of the term. Others have sought 
to qualify it by more complex phrases, but the multiplication 
of words does not increase ideas. It seems that such a 
mongrel expression as " para-lucid intervals " which has 
been suggested by one American authority can hardly be 
approved. 

In the form of insanity termed " circular " or " periodic," 
conditions of exaltation, depression and apparent sanity 
occur. The last condition is sometimes regarded as a true 
lucid interval, and would be so regarded, in many cases, by 
non-medical persons. The medical authorities, however, do 
not accept this view. A careful inquiry into the patient's 
condition will show that the mind is not quite normal. It is 
a remission not a recovery. 

Lucid intervals have been ascribed to mania and dementia. 
They have not been recognized in imbecility. 

In order to establish the existence of a lucid interval, the 
burden of proof rests upon the plaintiff in a suit in which he 
desires to prove the validity of a contract made by the lunatic 
during such interval. 

Varieties and Classification of Insanity. — Much differ- 
ence exists among the authorities in this respect ; the follow- 
ing will serve the purpose of the work probably as well as 
any system: 

1. Idiocy and Imbecility. 

2. Mania. 

3. Melancholia. 

4. Paranoia. 

5. General Paralysis of Insane. 

6. Dementia. 



INSANITY. 307 

7. Some forms of mania having distinct etiological re- 
lations. 

Idiocy and Imbecility are sometimes regarded as distinct 
phases of mental unsoundness, idiocy being the more pro- 
found defect and a fundamental congenital condition, but 
the distinction is not marked and it will not be necessary to 
adhere to it in this work. The causes of idiocy and imbecility 
have been as yet not definitely established. Intemperance 
and syphilis in the parents are generally regarded as predis- 
posing causes. Marriages in close consanguinity are held by 
many to be causes. The experience of the Jewish people, 
however, among whom marriages between first cousins are 
common, and even marriages between uncle and niece not 
unknown, does not seem to bear out this as a law of heredity. 
It has been claimed that defects, mental or physical, are 
more apt to be transmitted to offspring when parents are in 
close consanguinity, and this view has led to the forbidding 
of such marriages in many places.. Pennsylvania, for ex- 
ample, has a law forbidding the marriage of first cousins. 
Incidents and accidents of pregnancy and parturition are 
causes of idiocy. 

Idiocy is distinguished from other forms of mental dis- 
order by being congenital; and this condition is manifested 
by imperfect development of both body and mind. The idiot, 
from an original defective structure of the brain, is able to 
acquire only a limited degree of intellectuality. His instincts, 
habits, and appetites are largely animal. Often there is no 
sign of recognition, nor indication of memory, in which re- 
spect he is below many animals. There are some cases of 
idiocy, however, in which the want of cerebral development 
is not so great, and some intelligence is manifested, with a 
partial development of some few of the faculties. Such idiots 



308 MEDICAL JURISPRUDENCE. 

are docile and tractable ; they are capable of being taught 
many things by careful and judicious training, even to talk 
and read ; and thus of being materially improved. 

Physical Peculiarities of Idiots. — These are manifested 
in smallness of the head, in the majority ; thickness of the 
lips, which are often fissured, particularly the lower one ; 
enlargement of the tongue, salivary glands, and tonsils ; 
vaulting of the hard palate; irregularity of the teeth, with 
tendency tO' early decay; deficiency of the lobules of the 
ears; defects of vision, such as myopia and congenital 
cataract ; weakness and clubbed appearance of the fingers 
and thumbs, and want of power over the sphincters. In 
some idiots the head is preternaturally large, especially in 
congenital hydrocephalus. 

An autopsy will generally disclose a deficiency of gray 
matter (from a defective size of the brain) and a want of 
proper development of the convolutions ; sometimes an 
absence of the entire cerebellum, of the pineal gland, of 
part of the fornix, of the olivary bodies, thalamus, and 
corpus striatum; and an absence, or rudimentary state, of 
the corpus callosum and soft commissures. Deaf-dumb- 
ness is common. Some are born deaf, dumb, and blind ; 
yet, in the case of Laura Bridgman, the deprivation of all 
these faculties did not prevent acquiring a remarkable de- 
gree of intelligence, under careful training. 

While the higher faculties are wanting, there often exists 
a marked development of the lower ones, such as the love of 
money, sexual feelings, gluttony, and filthy habits, together 
with a slow and tottering gait. 

Cretinism. — A peculiar form of idiocy, at one time sup- 
posed to be endemic in certain mountainous countries, as 



INSANITY. 309 

Switzerland, Savoy, etc. It is chiefly marked by an enor- 
mous development of the thyroid gland, which, however, in 
some cases, may be altogether absent. The mouth is large, 
and the hands and fingers misshapen. The eyes are squint- 
ing, the face pale and sallow, and the speech thick and 
muffled. The intelligence is about that of idiocy. The 
smaller goiters found in other countries do not necessarily 
impair the intellect. 

Imbecility, as the term is understood by some authorities, 
diflFers from idiocy chiefly in the fact of the former being 
acquired after birth ; the bodily defects are also asymmetrical, 
and the intellectual manifestations are rather different, being 
exhibited in low, mischievous cunning, bad temper, silliness, 
and stupidity, and may often be accompanied with epilepsy 
or paralysis (Hamilton). The power of speech is less fre- 
quently absent than in idiocy. Neither of them is likely to 
be confounded with mania and monomania, since in the 
former there is a total absence of ideas and of the power of 
thought, both of which are present in maniacs and mono- 
maniacs, although perverted and irregular. Moreover, 
idiocy and imbecility are destitute of hallucinations, which 
are characteristic of mania and monomania. Their resem- 
blance to confirmed dementia is much stronger. 

Legal Relations ^of Idiocy and Imbecility. — When these 
mental conditions are positive and distinct, there can be 
no question of their entire irresponsibility, both civil and 
criminal. 

Mania. — This variety of mental disorder is characterized 
by a general perversion of the mental faculties, accompanied 
by more or less excitement, sometimes amounting to fury. 
The reasoning faculty is not absolutely lost, but disturbed 



3IO MEDICAL JURISPRUDENCE. 

and confused ; ideas flow through the mind without order 
or connection; they are evolved from the brain in chaotic 
exuberance, following one another with inconceivable rapid- 
ity and entirely without control. With the maniac every- 
thing is active — the emotions, the memory, the imagination, 
the speech, and the features. " He mingles abusive, obscene, 
and blasphemous words with the most pious reflections." 
His movements are brusque, disorderly, and extravagant ; 
he dances, runs, leaps, tears off his clothes, breaks things, 
and exhibits enormous strength. The voice becomes hoarse, 
the skin is dry and hot ; the eye has a peculiar, wild, brilliant 
expression, with often a fixed stare. The pulse is rapid, and 
respiration and temperature above normal. They generally 
eat enormously and voraciously. Urine and feces are often 
passed involuntarily ; the bowels are apt to be torpid ; per- 
spiration abundant and sour. There is frequently sexual 
excitement, particularly in females, and when this is the 
chief feature of the mental disturbance, it is called satyriasis 
in males, and nymphomania in females. 

Along with the intellectual, the moral faculties become 
more or less perverted, and the patient's social and domestic 
relations are greatly altered, jealousy, suspicion, and hatred 
being evinced toward those whom he had formerly loved 
with the deepest affection. He is haunted by the wildest 
delusions, under whose influence he may act in the most 
dangerous and ungovernable manner. 

Melancholia differs materially from the first (mania pro- 
per), in being connected with depression instead of excite- 
ment. Delusions may not always be present, or, at least, 
not be observable ; the sufferer is gloomy and the prey to 
unhappy and desponding thoughts, which often lead to 



INSANITY. 3 I I 

suicide ; he is sleepless, refuses food, often under the delu- 
sion that it is poisoned. The delusions and hallucinations 
may assume an infinite variety of shapes ; they are often of 
a religious character, and very frequently connected with 
an idea of undergoing persecution. This latter delusion is 
very common, and under its influence the sufferer may 
resort to homicidal violence toward those whom he may 
imagine are his enemies. He should, therefore, be con- 
stantly watched. 

This form of mental disorder rarely exists in an uncom- 
plicated form ; it is apt to be alternated with fits of excite- 
ment (mania). The physical characters of melancholia are 
quite characteristic. " The patient, if a female, is dirty in 
her habits, soiling her clothes, and paying little attention to 
her appearance. With disordered hair and averted eyes 
the melancholic sits by herself, lost in her own reflections, 
although there are some who are communicative and loqua- 
cious." '' The face is pinched and wan, and unnaturally 
pale ; the eyelids droop and the facial folds are dependent ; 
the lips are bloodless ; the pupils are dilated, and every- 
thing indicates inaction ; the hands are livid and hang idly, 
and the maintenance of a fixed position, sometimes for 
hours at a time, is characteristic of the intellectual torpor." 
(Hamilton.) 

Paranoia. — This form of insanity formerly termed mono- 
mania, is also often designated primary delusional insanity. 
'' The patient, in the simplest form of the disease, becomes 
possessed of some notion, which is alike contradictory to 
common sense and to his own experience" (Husband). 
Sometimes it may have reference to some fancied bodily 
disease, as where he believes he has a snake or a lizard in 



312 MEDICAL JURISPRUDENCE. 

his stomach ; or, as in the case of the woman mentioned by 
Esquirol, who had hydatids in the uterus, and who beUeved 
that she was pregnant by the devil. 

Among the manifestations of delusional insanity, delusions 
of poisoning are very common. The individual becomes 
suspicious of food and imagines that it produces strange 
symptoms. The condition is much more common in men 
than in women, and when it develops in a man living with 
his wife, she is usually so strongly suspected that she is in 
bodily danger. The dread that has taken possession of the 
patient leads him to eat at other places than home, but even 
these become in time suspected, and he may seek to prepare 
his own food in a solitary residence. In many cases, the 
patient seeks a chemist, bringing a curious assortment of 
scraps of meat and bread, coffee slops and other remainders, 
furtively collected at a meal. Often the chemist will be 
given a recital of woes, which, having been either told or 
thought over so much, will sound like a child's essay, learned 
by rote. 

Moral Mania. — The title " moral mania " has been as- 
signed, by Dr. Ray and others, to those cases of mental 
disturbance which, in the language of Prichard, " consist in 
a morbid perversion of the natural feelings, affections, in- 
clinations, temper, habits and moral dispositions, without any 
notable lesion of the intellect or knowing or reasoning 
faculties, and particularly without any maniacal hallucina- 
tions." There is considerable diversity of opinion among 
writers as to the existence of moral insanity as a distinct 
variety of mental disorder. Some deny its existence as 
such, and assert that there can be no derangement of mind, 
without the intellect being affected. Such authorities are 
disposed to regard the merely moral perversions above 



INSANITY. 3 I 3 

alluded to as evidences of a moral obliquity, showing an 
excessive perverseness of character, rather than a derange- 
ment of mind. What has been termed emotional insanity, 
in modern times, partakes of this character. It must cer- 
tainly be rare that any person becomes suddenly affected 
with an insane homicidal impulse ; and unless it can be 
clearly shown that the culprit had exhibited previous un- 
equivocal signs of. insanity, or had a strong heredity thereto, 
such a plea as that of emotional insanity is not likely to be 
allowed. Unquestionably, the moral faculties are perverted 
in insanity, often, to appearance, more decidedly than 
those of the intellect; but it is rare, if ever, that they are 
exclusively deranged. The manifestations of a disordered 
mind may assume an almost endless variety of forms, 
doubtless dependent somewhat on the natural disposition 
or mental conformation of the patient. In some, the intel- 
lectual perversions will be more pronounced ; in others, 
disturbances of the moral faculties, affections, and senti- 
ments are more obvious. Hence, it would be highly dan- 
gerous to pronounce a person insane unless there was some 
evidence of intellectual disturbance along with exhibitions 
of a depraved moral nature. It would be offering an ex- 
cuse, or at least a palliation, for all sorts of moral obliquity. 
The law does not recognize moral insanity as an inde- 
pendent state ; " hence, however perverted the affections, 
moral feelings, or sentiments may be, the medical jurist must 
always look for some indications of disturbed reason " 
(Taylor). Although, according to Dr. Prichard, there are 
two forms of insanity (moral and intellectual), in law there 
is but one — that which affects the mind. 

The term " partial moral mania " has been assigned to 
such cases of mental action as are manifested by certain 
28 



314 MEDICAL JURISPRUDENCE. 

forms of moral perversion, when only one or two phases 
of the moral powers are deranged. Different names are 
employed to designate these. 

Kleptomania, or a propensity to steal, as shown in persons 
of excellent moral character in other respects, and whose 
easy, and even affluent, circumstances preclude the idea of 
want as a motive inciting to the crime. Some kleptomaniacs 
appear to be sensible of their fault, and are ready to confess 
and lament their unhappy propensity. There are, however, 
cases of so-called kleptomania in which there is a perfect 
consciousness of the act, and of its illegality; where the 
article stolen, although of trifling value, was yet of some use 
to the person; where art and precaution were employed in 
the theft; and where there was, subsequently, a denial of 
the act, or some evasive excuse. Of such persons it might 
more properly be said that their organ of secretiveness was 
very largely developed. In a trial of a case of this kind it 
must be shown that the prisoner was incapable of under- 
standing that the particular act in question was a wrong 
one. Otherwise, the whole class of thieves might equally 
urge the plea of insanity as a palliation of their crimes. 

Pyromania. — A propensity or impulse to set fire to every- 
thing — houses, barns, churches, etc., without any motive. 
Hamilton speaks of it as being often connected with a variety 
of epileptic insanity. It is rare to find this moral perversion 
disconnected with other morbid impulses, especially homi- 
cidal or suicidal. A well-known historical instance of 
pyromania is that of Martin, who attempted to set fire to 
York cathedral. Many cases of so-called pyromania will 
be found, on investigation, to originate in personal grudge 
or revenge. 

Dipsomania — Responsibility of Drunkards. — By this term 



INSANITY. 3 I 5 

is understood that form of insanity which manifests itself in 
a craving for alcohol — a craze for drink. It differs from 
the habitual desire for liquor of the ordinary dram-drinker 
in the fact that there are distinct remissions of the disease, 
during which there is not the slightest longing for drink 
experienced, but rather a loathing for it ; but when this 
interval has passed away, the inordinate desire returns, and 
the unhappy victim will plunge into violent excesses, often 
frequenting the lowest taverns, and spending days and 
nights in literally saturating his system by drinking enor- 
mous quantities of brandy and other spirits. During these 
excesses the person shuns all society, and remains often 
secluded for many days and even weeks. 

As regards the responsibility of drunkards, opinions differ. 
There can be no question that where the mind has become 
completely weakened by habitual drunkenness the law would 
infer irresponsibility, unless it was clear that at the time 
of the act the person was fully aware of its nature and 
criminality. In a case of complete inebriety, where there 
is entire loss of consciousness, the individual is incapable of 
giving a valid consent ; consequently, any deed or contract 
then executed would be invalid ; but if the intoxication be 
only partial, so that the party knew what he was about, the 
act or deed would be held to be valid. A confession made 
by a partially drunken man is legally admissible as evidence 
against him, provided it is corroborated by circumstances. 

The criminal responsibility of drunkards is more rigidly 
regarded by the law than their civil responsibility. Thus, 
murder committed by a drunken man is not extenuated be- 
cause his brain may have been crazed by drink, if volun- 
tarily induced on his part. If it can be shown that the 
drunkenness has produced a disease of the mind to such an 



3l6 MEDICAL JURISPRUDENCE. 

extent as to have deprived him of a consciousness of the 
illegality of the act, then his irresponsibility must be ad- 
mitted. A mitigating circumstance in such a case would 
be, if it could be- shown, that the prisoner was not actuated 
by malice or grudge against the deceased, but had killed 
him while under the effects of alcoholism. 

Although drunkenness does not excuse crime in the eye 
of the law, yet the insanity which may result from habitual 
drunkenness does certainly confer irresponsibility. So, like- 
wise, it has been decided in some cases of delirium tremens, 
when the brain is temporarily diseased, so as to render the 
individual incapable of reason. 

Homicidal Mania. — In this form of madness the pro- 
pensity to homicide is very great. There may, or may not, 
accompany it some intellectual aberrations ; but the charac- 
teristic feature is an uncontrollable impulse to take life, — 
often of those dearest to the unhappy victim, — actuated by 
some delusion which has, perhaps, been preying upon his 
mind for months before, but only now suddenly breaking 
out. Many striking cases of this form of insanity are re- 
corded in the books, all, however, evincing other unmistak- 
able signs of intellectual disturbance. 

The following suggestions, taken chiefly from Husband, 
may aid in forming a diagnosis of the existence or non- 
existence of this form of insanity : — 

I. Inquire into the previous history of the person: Was 
he morose, melancholic, apprehensive of impending evil, 
etc.? Had he previously received a fall upon his head, or 
been otherwise injured? Such a homicidal propensity rarely, 
if ever, manifests itself suddenly for the first time, like a 
flash of lightning out of a clear sky ; it is almost invariably 
preceded by other symptoms of mental disturbance, and 
usually of a melancholic character. 



INSANITY. 317 

2. Ascertain the presence or absence of a motive — a most 
important factor in the responsibility of the accused. Often 
the real motive may be so deeply hidden in the breast of 
the culprit as to be completely concealed from the view of 
others, and scarcely recognized by himself. 

3. A number of victims may be sacrificed at one time by 
the madman ; the ordinary murderer, on the other hand, 
seldom sheds more blood than is necessary for his success. 

4. The conduct of the accused before and after the crime ; 
the insane man -usually makes no attempt to escape, but 
rather glories in the bloody deed, assigning his conduct to a 
divine or spiritual impulse. 

5. The character of the victims. Not infrequently the 
madman destroys those who were the dearest to him while 
he was sane, and for whose destruction he could have had 
no conceivable motive. 

Suicidal Mania. — This form of insanity displays itself by 
the prominent idea of self-destruction. Considerable diver- 
sity of opinion exists upon the question whether suicide 
is always to be regarded as evidence of insanity. Many 
instances of suicide may be ascribed to insanity ; but there 
are numerous other instances where the act of self-destruc- 
tion is deliberately perpetrated with a distinct motive and 
for a purpose. Suicide was at one period of the world's 
history regarded as rather a praiseworthy act on the part of 
persons wearied of life. Philosophers, poets, statesmen, 
generals and moralists believed in it and practiced it. Even 
at the present date it exists under national and popular sanc- 
tion in India and Japan. In our own times and country we 
have almost daily examples of deliberate suicides for whom 
the plea of insanity could never be urged. Moreover, the 
laws of most modern civilized countries regard suicide as 



3l8 MEDICAL JURISPRUDENCE. 

a crime, which they could not consistently do if it was 
merely the manifestation of disease (insanity). Conse- 
quently, the argument is unanswerable;, that many cases of 
suicide are the result of a perfectly sane and deliberate pur- 
pose acting upon the unhappy victim, and leading him to 
prefer death by his own hand rather than endure the miser- 
ies of his present existence. 

The almost uniform verdict of coroners' juries in cases of 
suicide — " death by his own hands, while laboring under 
temporary insanity " — would seem to give some weight to 
the popular idea that suicide was always the result of in- 
sanity ; but this is doubtless to be ascribed to a natural 
desire on the part of public officials to soften as much as 
possible the features of the death, in consideration of the 
feelings of the surviving relatives. 

In cases of true suicidal mania it may happen that a 
latent delusion, often assuming the form of hallucination, 
may have been haunting the victim for months before the 
perpetration of the fatal act ; while in other instances, the 
impulse is sudden and apparently unpremeditated. Even 
in the latter case it will usually be found, on careful exam- 
ination into the previous history of the person, that there 
were some former manifestations of mental disorder. The 
case of the barber (mentioned by Sir C. Bell), who cut his 
own throat immediately after hearing a surgeon, whom he 
was shaving, describe the proper mode of performing that 
deed, illustrates the suddenness of the impulse in some 
cases of suicide; but it is possible that the mind of this 
man had been frequently dwelling upon this subject pre- 
vious to the commission of the deed. 

It is well understood that the law does not regard suicide 
as evidence of insanity, so that the validity of a will executed 



INSANITY. 319 

by one who subsequently takes his own Hfe is not affected 
thereby. 

The relation of suicide to life insurance is one of great 
practical importance from a medico-legal point of view. The 
policies of most life insurance companies, until very recently, 
contained a clause to the effect that the policy became void 
if the insurer should " die by his own hand " — making no 
distinction whatever between a felo-de-se committed delib- 
erately and intelligently and a suicide resulting either from 
the acute delirium of fever or from a more chronic form of 
mental disease. Most assuredly, if regarded from an equit- 
able standpoint, the policy should not be forfeited under 
these latter circumstances, any more than if the death of 
the insured had been caused by apoplexy or by any casualty. 
How absurd it would seem for any company to make its 
insured responsible for that diseased mental condition which 
may culminate in an insane act of self-destruction, any more 
than for an attack of phrenitis, arachnitis, or typhoid fever, 
in all of which there may be acute delirium, driving its vic- 
tim to an act of suicide ! The line should be sharply drawn, 
in cases of life insurance, between intelligent suicides and 
insane suicides — the former being held responsible for the 
act of self-destruction, and, therefore, vitiating their policy ; 
while the latter are to be regarded as irresponsible, and con- 
sequently not vitiating their policies. Any other ruling 
seems unjust. Many life companies have ceased to claim 
suicide and intemperance as disqualifying causes for non- 
payment. 

In this connection one must not lose sight of the im- 
portant distinction between doing an act intentionally and 
doing it intelligently. The insane person, equally with the 
man of sound intellect, commits the suicidal act intention- 



320 , MEDICAL JURISPRUDENCE. 

ally, i e., he cuts his throat, shoots himself with a pistol, 
drowns, or hangs himself, intending to take his own life 
thereby; but there is this all-important distinction between 
the two: the sane man does the deed intelligently as well 
as intentionally, fully aware at the time of the illegality of 
the act and of all of its consequences both here and here- 
after. The insane man, on the contrary, commits the act 
with his mind not in its normal equipose, but swayed by an 
insane delusion. 

There is a form of suicide which might give rise to con- 
siderable casuistry in cases of life insurance : in which a per- 
son in the habit of using powerful drugs, such as laudanum 
or chloral, for medicinal purposes, takes a very large dose 
while in a state of intoxication, and dies. In such a case 
the act of self-destruction, not being intentional, could hardly 
be deemed felonious, and therefore not coming within the 
statute. But, on the other hand, as drunkenness is not a 
legal excuse for homicide, it might be made to affect the 
question of suicide also, which thus, under the circum- 
stances, might be held as felonious killing. 

As remarked by Taylor, if suicide is in all cases the 
result of insanity, the act ought to be more frequent among 
the insane. Experience does not favor this idea. The 
report of the British Commissioners of Lunacy for 1850 
shows that out of 15,079 persons that year confined as 
lunatics, there occurred only eight suicides. 

The suicidal tendency, or impulse, appears at times to 
assume an almost epidemic tendency in a community. Imi- 
tation has, undoubtedly, much to do with this, especially 
when the mode of self-destruction adopted and the attend- 
ing circumstances were of a peculiarly sensational character. 
Thus, a second and a third suicide took place in rapid sue- 



INSANITY. 321 

cession, soon after the first, by jumping from the top of one 
of the monuments in London. The same thing occurred in 
Paris from the Napoleon monument. Dr. Forbes Winslow 
states that " some years ago a man hung himself on the 
threshold of one of the doors of the Hotel des Invalides. No 
suicide had occurred in the establishment for two years pre- 
viously ; but in the succeeding fortnight five persons hung 
themselves on the same cross-bar, and the governor was 
obliged to shut up the passage." The tendency to suicide 
seems to be hereditary in certain cases, extending through 
several generations. But in all these instances there were 
other unmistakable evidences of a deranged mind. 

General Paralysis of the Insane. — This affection, known 
also as " paretic dementia," is a disease of the brain, char- 
acterized by both mental and motor symptoms. Its approach 
is gradual and insidious. It often follows alcoholism and 
syphilis, and sometimes mental overwork of any kind — any 
cause that occasions a continuous overstrain, up to the point 
of exhaustion, upon that portion of the cerebral mass in 
which mentalization especially resides. This function is held 
to be especially located in the gray substance of the convolu- 
tions. Its outer layer or rind is most delicately constituted, 
has far more blood and more minute cells than any other 
portion of the brain, and on the whole may be regarded as 
the most important factor in mentalization, being, in fact, 
the mind-tissue. General paralysis is a disease of this outer 
layer of the cerebral convolutions — of the mind-tissue, in 
fact. " It is essentially a death of that tissue. It is equiva- 
lent to a premature and sudden senile condition — senility 
being the slow physiological process of ending, general 
paralysis the quick pathological one. The causes of it are 



322 MEDICAL JURISPRUDENCE. 

causes that have exhausted the trophic energy by over- 
stimulation." 

It may begin with scarcely perceptible alterations in 
manner, fretfulness, irritability, and carelessness in habits, 
which are soon succeeded by ridiculous boastings of posses- 
sions and personal abilities (delusions of grandeur). These 
delusions assume various forms and expressions ; sometimes 
it is enormous wealth of money and jewels ; again, it is 
herculean strength of body, or wonderful mental capacity; 
again, it may take the form of extraordinary sexual capacity. 
Along with these there is the most foolish extravagance, 
purchasing the most useless articles and throwing away 
money with the most reckless prodigality. " At this time 
there will be noticed a loss of muscular power ; at first, the 
tongue will tremble when protruded ; then the lips become 
tremulous, and the corners of the mouth uneven ; the speech 
is clumsy, and there is great difficulty in pronouncing the 
labial and lingual consonants" (Hamilton). The pupils 
are apt to be unequally dilated, or they may both be much 
contracted. 

As the disease advances, the gait becomes unsteady and 
trembling. Vision is also impaired, as are also the other 
senses. Fits of violence often alternate with a melancholic 
condition, and epileptic and hemiplegic attacks may com- 
plicate the case toward the last; but, as has been already 
suggested, these may be indications of some organic dis- 
order which occasionally accompanies the disease. 

There are periods of remission in general paresis, during 
which the individual appears quite sane. These may last 
for weeks or months. During these intervals the question 
of his testamentary capacity may be raised, which, of course, 
would have to be decided according to the actual mental 



INSANITY. 323 

condition of the patient. If under an extravagant delusion 
extravagant and unjust bequests were made, these should, 
undoubtedly, be set aside, as being the offspring of a de- 
ranged mind. 

The prognosis in general paresis is always unfavorable ; 
the disease progresses to a final termination, though not 
always rapidly. 

Dementia. — This term is used to define the condition 
manifested by a decay of the mental powers. Commencing 
with a gradual enfeeblement of the mind, it may terminate 
in its total extinction. It differs totally from mania in being 
attended by a lack of ideas, while the former is characterized 
by an exuberance of ideas, although these are confused 
and incoherent. Dementia is essentially a disease of depres- 
sion ; mania, one of excitement. It may follow acute mania 
or melancholia, or result from cerebral organic disease or 
injury, and it is a frequent accompaniment of old age (senile 
dementia). Its most striking symptom is loss of memory, 
this faculty being the first to show signs of decay. This 
progressively increases, until everything seems to be for- 
gotten by the patient, even what he has seen, or heard, or 
done only a few moments before. 

The general mental feebleness is further manifested by 
the " wavering play of worn-out emotions, incoherence, and 
half-formed and varying delusions " (Hamilton). The delu- 
sions are of a suspicious character ; the patient is unde- 
cided, childish, and silly in his manners ; his conversation is 
incoherent; he will repeat words or sentences without any 
meaning; he manifests neither partiality nor aversion to 
former friends or acquaintances ; he moves about aimlessly 
for hours, or may remain for days in the same attitude. 



324 MEDICAL JURISPRUDENCE. 

There is often a strong disposition exhibited for hoarding 
up useless articles, as if they were of great value. The 
countenance is generally pale, vacant, and without expres- 
sion; the look vague and uncertain, and tears are often 
easily shed, from the slightest cause. 

Secondary dementia, following disease of the brain, is 
usually gradual in its approach, the decay of one mental 
faculty following another, and accompanied, also, with pro- 
gressive physical weakness. Such cases are popularly 
known as " softening of the brain " ; and there is probably 
no sadder spectacle to witness than the gradual decay, 
through disease, of both mind and body, in one whose 
former brilliant intellect is slowly but surely giving place to 
the fatuity of dementia. 

Dementia is thought to follow mania more frequently 
than melancholia ; and although it may seem to resemble 
the latter form of insanity in some of its features, it differs 
from it in exhibiting less coherence of ideas and less ability 
to keep up the continuity of the delusions. 

Senile dementia is usually marked by a failure of both 
the bodily and mental powers ; it exhibits itself by loss of 
memory and childishness. The person is cross and petu- 
lant, uncertain in action, careless, and often filthy in habits ; 
wandering about aimlessly ; often foolishly extravagant. 
The patient gradually sinks into a state of complete fatuity, 
and finally dies of exhaustion. 

Dementia Precox. — This term includes several forms of 
insanity, appearing in early life. The term being somewhat 
contradictory, since dementia is rather the termination of 
mental unsoundness, the usual scientific expedient of sub- 
stituting terms from Latin or Greek has been followed. 
Lloyd {Wharton &Stille, Med. Jur.,Yo\. 3) regards the term 



INSANITY. 325 

as acceptable and notes three divisions that have been recog- 
nized by some authorities. Hebephrenic form : alternations 
of melancholia with exaltation, and tendency to commit acts 
of violence without motive. Katatonic form : which shows 
similar symptoms to the first form, but also a tendency to 
cataleptic attitudes and to automatism. Paranoid form: 
delusions of persecution or of exaltation are prominent. 

This phase of insanity has considerable practical relation 
to the prevention and punishment of juvenile crime, now 
such an important matter in large cities that in some places 
a special court is assigned to try these offenders. Many 
children are committed to jail or reformatories, who should 
be committed to asylums where they can receive full scientific 
care, both as to the mental condition and for training for 
suitable labor. 

Puerperal Insanity. — This form of insanity attacks 
women at a period varying from a few days to several 
weeks after 'delivery. It is said to occur most frequently 
before the cessation of the lochia. It is usually attended 
with the appearance of albumin in the urine, and with the 
interruption or suppression of the milk and lochia. The 
disorder may assume any form of mania, from the grave to 
the gay, loquacious, taciturn, correct or foul in talk, attended 
with delusions of a religious character, or of persecution. 
The patient is apt to forget recent events and not to recog- 
nize persons. Her infant is either disregarded, or becomes 
the object of stealthy destruction. Instances are reported 
of the most horrible murders of their offspring by mothers 
suffering under this form of insanity. Crimes of this char- 
acter are sometimes committed from a seemingly sudden 
impulse ; whilst, in other cases, they may be preceded by 



326 MEDICAL JURISPRUDENCE. 

torturing doubt; and the very sight of the child has 
aroused the almost invincible desire to murder it. Dr. 
Reese notes the case of a lady who had completely recov- 
ered from her first confinement, and was able to go out. 
One day, several weeks after the birth of her child, she 
was visiting at a friend's house, when, all of a sudden, she 
broke out into the most violent paroxysm of mania, re- 
quiring bodily restraint. She took a strong dislike both to 
her husband and child. She was treated in different asy- 
lums for about one year, when she completely recovered, 
and has continued well ever since, having also given birth 
to another child. Women suffering from puerperal mania 
are apt to commit the most unexpected crimes, which, at 
times, may be misunderstood by juries, and may be mis- 
taken for instances of intentional infanticide. Fortunately, 
however, for the diagnosis of the case, the crimes are bru- 
tally executed, and often more than one person is murdered, 
so that no doubt can be raised as to the real condition of 
the patient. 

Somnambulism. — The degree of responsibility for acts 
committed in sleep-walking, or somnambulism, is on a par 
with those committed in delirium tremens — i. e., there is no 
responsibility. In the " unconscious cerebration " during 
sleep it is presumed that intention and malice, the chief 
ingredients of crime, are wanting. So, also, in the case of 
a person half-awake, suddenly aroused under the effect of 
a delusion of a dream, who may make a murderous attack 
upon his wife or child, supposing he is defending himself 
against a mortal enemy, no criminal responsibility would 
be imputed to him. 



INSANITY. 327 

Epileptic Insanity. — The majority of epileptics sooner 
or later show mental deterioration. According to Esquirol, 
out of 339 epileptics in the Salpetriere, 12 were mono- 
maniacs ; 64 were maniacal ; 34 were furious ; 145 were 
imbecile or demented ; 8 were idiotic ; 50 were habitually 
rational, but with loss of memory, exaltation of ideas, some- 
times a temporary delirium, and a tendency to dementia ; 
60 had no derangement of intellect, but were very irritable, 
irascible, obstinate, capricious and eccentric (Ray). An 
investigation of the epileptic wards of any large hospital 
will give similar results. An epileptic may be the victim 
of mania, melancholia, paranoia, or paretic dementia. Any 
form of insanity may, in fact, be associated with epilepsy, 
but a certain type of mental disease is especially regarded 
as epileptic, and this may become of great forensic impor- 
tance. It is usually studied in its relation to the motor 
paroxysm or fit, and from this point of view can be subdi- 
vided into I, post-epileptic insanity, which follows the con- 
vulsive attack ; 2, pre-epileptic insanity, which precedes the 
attack ; 3, the psychical substitute of the attack ; 4, insanity 
occurring in the interval between the attacks. 

The psychical disturbances which occur before, after, or 
as the equivalent of the fit. may be of much the same 
character, although post-paroxysmal outbreaks are most 
likely to be maniacal. Preceding the fit the epileptic fre- 
quently shows great irritability, moroseness and suspicion. 
Mann well describes a typical post-epileptic condition as 
follows : " After a fully-developed seizure the patient usually 
sleeps profoundly for a variable period, and on awakening 
is in his former condition, except that he feels sore and 
fatigued ; in some cases automatic movements are made 
before consciousness returns. A man may have a fit in the 



328 MEDICAL JURISPRUDENCE. 

street, and after it is over may get up and walk a consider- 
able distance without any perception of his surroundings; 
when he comes tO' himself he finds that he is in a neighbor- 
hood quite unknown to him. Whilst in this condition he 
may perform a variety of actions of a purposive nature which 
demand complicated movements for their execution. The 
actions performed are determined by the influence of past 
coordinations on the motor centers acting in the absence of 
the restraint imposed under normal conditions by the highest 
controlling centers, the latter being in a state of passivity 
from exhaustion. Many of these actions present all the ap- 
pearance of volitional movements, and yet the individual, both 
at the time and afterward, is quite unconscious of having 
performed them; although described as automatic, they are 
probably initiated by a slight peripheral stimulation, or by 
one of internal origin." 

The remarkable affection of memory and consciousness 
known under such names as periodic amnesia, periodic 
asynesia, double consciousness, and alternate consciousness, 
is allied to epilepsy. The medico-legal problems which 
arise in connection with those suffering from this disorder 
belong to the subject of epileptic insanity. Medical litera- 
ture has furnished us with striking illustrations of this 
disorder, some worthy of credence; and novelists and 
newspapers have woven from such phenomena stories of 
thrilling interest, in which, however, the facts, as a rule, 
are far from keeping pace with the fiction. Among epi- 
leptics, periodic amnesia, or an allied state, is observed in a 
variety of forms. Instead of passing into a maniacal state, 
many epileptics, after a fit, if sleep does not ensue, become 
dazed, confused, or somnambulistic. Others have attacks 
which have been described as epileptic automatism, con- 



INSANITY. 329 

cealed epilepsy, or masked epilepsy, in which are performed 
unusual, grotesque, or vicious acts, which may bring the 
persons within the purview of the law. Among such acts 
are undressing or urinating in public. It will, of course, 
often be extremely difficult to convince authorities that 
such a performance is not criminal. 

In some cases crimes are committed by those who are 
probably epileptic, or at least sufferers from some of the 
epileptoid affections of consciousness and memory, but who 
are not known to be thus afflicted. A remarkable case has 
been reported by Yellowlees. The patient had a clear his- 
tory of somnambulism and night-walking from when he was 
a mere lad until the time when he committed the crime for 
which he was tried for his life. He became more and more 
subject to somnambulistic seizures as he grew older, and 
these attacks were accompanied with great terror and with 
the appearance of visions of wild beasts and other horrible 
things. Sometimes he would tear his wife and child from 
the bed while fiercely chasing wild beasts through the room, 
at the same time striking with anything upon which he 
could lay his hands. In one of these terrible paroxysms he 
hurled his child with such force against the wall that it fell 
dead. He was tried for his life, and the jury found the man 
was unconscious of the nature of the act which he had com- 
mitted, by reason of a condition arising from somnambulism, 
and that, therefore, he was not responsible. When put on 
trial the man entered the following strange but just plea : 
*' I am guilty in my sleep, but not guilty in my senses." 

It is probable that many epileptics have been punished 
for homicide, theft, arson, assault, and other crimes com- 
mitted without their true volition, although the acts were 
apparently purposive ; but it is often a task of extreme 
29 



330 MEDICAL JURISPRUDENCE. 

difficulty to decide as to the insanity of an epileptic at the 
time of the commission of a crime. Zacchias contended that 
epileptics should not be responsible for any acts committed 
within three days of a fit, before or after ; but no rule can 
be invariably followed. It is not correct to conclude that 
the mere existence of epilepsy is sufficient to establish un- 
soundness of mind and irresponsibility ; but each case should 
be decided on its own merits, after a careful investigation of 
the family and previous history of the accused and of the 
circumstances surrounding the crime. 

It is altogether probable that transitory mania or tran- 
sitory frenzy, so called, is sometimes epileptic in origin, 
although the claim that has been made that this form of 
insanity is always cerebral epilepsy cannot be maintained. 
When a crime has been committed in an attack of transitory 
fury or of apparent passion, it is important to inquire 
closely as to the existence of epilepsy. 

Post-mortem Lesions in Insanity. — Modern research 
has done much to elucidate what was formerly very obscure 
touching the true pathology of insanity. In every case of 
true insanity, especially in the chronic form of the disorder, 
there are pathological changes produced in the brain, 
although these may, at times, be too subtle and recondite 
to be discovered by our present means of research. If it 
be true that every abnormal alteration of function in an 
organ involves, for the time, an alteration of structure 
(although this may not always be capable of demonstration 
to the senses), it would seem most reasonable to refer those 
abnormal displays of the intellectual and mental functions 
which accompany insanity to some structural change in the 
different parts of the cerebral structure. 



INSANITY. 331 

It is a most vague and unsatisfactory mode of expression 
to speak of a diseased mind, as if the incorporeal, impalpable 
entity which we term mind was the real seat of disease ; 
whereas the true condition would seem to be that as the 
mind can only act, in our present state of being; through 
the brain, a diseased condition of the latter organ must 
necessarily affect and distort the different mental manifesta- 
tions. The doctrine that insanity is due to diseased physical 
media seems to be most consistent with sound philosophic 
and physiologic views — and w^e may add, also, with sound 
therapeutic views. For, as has been well urged, on what 
other grounds do we administer material remedies in cases 
of insanity, except with the expectation that these remedies 
will remove disease from the media? When this is ac- 
complished, the manifestations of the mind's operations again 
become normal and natural. 

On the other hand, it must be remembered that exten- 
sive disease of the brain may exist, and sometimes exhibit 
pathological changes very similar to those accompanying 
insanity, without marked indications of this disorder. Why 
this should be so we are unable distinctly to say. Heredity 
and other occult causes may produce effects whose opera- 
tions we are not yet prepared fully to understand and 
explain. 

It is a popular idea that the largest brains are found in 
persons of the greatest intellect; this is far from the truth, 
as one of the largest on record belonged to an idiot. 

In an autopsy of the brain in a fase of insanity, the points 
for consideration are its size, weight, and configuration, the 
appearance of the convolutions, depth of the gray substance, 
and marks of recent or chronic disease. In general, it may 
be stated that, in chronic cases particularly, the appearances 



332 MEDICAL JURISPRUDENCE. 

commonly met with are thickening of the cranial bones, 
close adhesion of the dura mater, congestion of the pia 
mater, with opacity and thickening of the arachnoid. There 
is also general fullness of the blood-vessels, with remains 
of old cysts, hardened deposits, or even abscesses in the 
cerebral substance ; alterations in the form and structure 
of the convolutions and depth of the gray matter ; also 
effusions of blood and serum, the latter into the ventricles, 
together with alterations and atrophy of the nerve-cells. 

In Idiocy and Imbecility the brain is usually smaller than 
natural (although there are exceptions), with partial atrophy 
of the convolutions, particularly the frontal. There is also, 
generally, a want of correspondence between the two lobes. 
The fissure of Sylvius is also, according to Luys, usually 
enlarged, extending much farther back than in the normal 
brain. In these cases there has been a true arrest of de- 
velopment, depending upon some defect in the cortical 
substance, from which intellectual nutrition should have been 
supplied. 

In Acute Mania the most common lesion is intense 
hyperemia along the whole margin of the gray substance 
of the convolutions and also in areas below them. This 
active congestion is not, however, to be regarded as the 
primary cause of mania ; otherwise, this latter disorder would 
frequently be the sequence of meningitis. According to 
Luys, the vessels of the corpora striata are most dilated and 
engorged. 

Clouston describes a singular pathological condition, 
noticed in a case of acute mania, consisting of a copious 
deposit of an abnormal material over the entire convolu- 
tions, "' chiefly in their inner layers, and extending, in some 
places, into the white substance, and replacing at least 



INSANITY. 333 

two thirds of the gray substance. In many places it was 
deposited in masses around the arteries." But that such 
an abnormal deposit is necessary to produce all the symp- 
toms of violent mania is fully disproved (as the author 
remarks) by the fact of its entire absence in other numerous 
cases. 

The pathological changes exhibited in chronic mania are 
not pathognomonic. We generally find thickening of the 
membranes, some atrophy of the convolutions, long con- 
gestions, together with disease of the coats of the vessels, 
with occasional spots of softening. There is, usually, 
thickening of the bones of the skull, with occasional exces- 
sive bony deposits on the inner surface. 

In Melancholia, *' Luys found, in several cases, great 
hyperemia of the gray substance of the third ventricle. 
This gray matter on the cortex of one of these patients 
was thin, and most of the convolutions were pale, with 
irregular vascular arborizations. In some cases of profound 
melancholia with stupor the brain was completely exsan- 
giiined, the white substance deprived of vessels, with atro- 
phy of the cortex" (Hamilton). 

The pathology of epileptic insanity, like that of epilepsy, 
yet remains very obscure. According to Dr. Clouston, 
who has examined numerous cases of this disorder, *' there 
is no special lesion or abnormality." Among other lesions 
he has found " spiculse of bone from the skull-cap and 
membranes pressing into the convolutions, apoplexies, de- 
structive lesions of the brain of all kinds and in all places, 
embolisms, fatty and otherwise, adhesions of the pia mater 
of the convolutions, the marks of traumatic injuries of all 
kinds and in all places, unequal hemispheres, and conges- 
tions of all sorts and in all places." This author does not 



334 MEDICAL JURISPRUDENCE. 

believe that the source of irritation, in epilepsy, exists in 
the pons and medulla oblongata, but thinks that an irrita- 
tion of the motor area of the convolutions is far more apt 
to cause it than one anywhere else. 

In insanity due to syphilis we may expect to find a 
variety of pathological changes, consisting, chiefly, in thick- 
ening of the bones of the cranium, and of the membranes 
which adhere to the bones and to the convolutions ; atrophy 
of the convolutions, adventitious deposits in the gray mat- 
ter ; softening and disappearance of the white matter ; tumors 
(syphilomata) in different places; hypertrophy of the coats 
of the arteries, obliterating their lumen, thus causing atrophy 
of the structure. There is believed to be a tendency in 
syphilis to attack the brain, after having lain latent for 
many years. Moreover, it appears that the tendency of the 
disease toward the nervous system is in the inverse ratio to 
the development of primary and secondary symptoms. 

In senile dementia the most usual pathological lesions, 
according to Clouston, are localized softenings of the cere- 
bral structure, the result of cutting off the blood supply 
through embolism ; atheroma of the arteries, also a marked 
atrophy of the whole brain or of considerable portions of 
the convolutions. The membranes are commonly thick- 
ened, and the cerebro-spinal fluid milky, superabundant, 
and full of microscopic debris. The large nerve-cells are 
degenerated and disappearing, along with atrophy of the 
smaller cells and nuclei. 

MEDICO-LEGAL RELATIONS OF INSANITY. 

The duties of the medical practitioner in connection with 
cases of real or alleged insanity involve grave responsibili- 
ties on his part, and require the exercise of judgment and 



INSANITY. 335 

caution. The most important of these duties are the fol- 
lowing : 

1. Assuming tlie responsibility of treating cases at home, 
assigning them attendants, restricting their liberty, and pre- 
venting their attending to their ordinary business. This is 
a serious undertaking, and the physician will do well, in 
such cases, merely to act as an adviser, but to assume no 
responsibility in the restraint ; this should devolve upon 
some relative of the patient. 

2. To sign the proper certificate for the admission of the 
alleged insane patient into a public or private asylum. This 
measure may become necessary both for the good of the 
patient and for the safety of the public ; but as interested 
relatives and others might possibly combine to commit a 
sane person into an asylum, and the physician, in such a 
case, is liable to be imposed upon, he should exercise the 
greatest caution and judgment before giving his signature ; 
otherwise he renders himself liable to heavy punishment, 
by an action at law, for false commitment. The form of 
certificate is fixed by statute, and no other is valid in the 
United States. This must be signed and sworn to by one 
or more respectable physicians, who have previously wit- 
nessed and examined the patient. In Pennsylvania, for 
instance, the law requires the signatures of two physicians 
who have been in practice for at least five years, and who 
have examined the patient separately within one week of 
their signatures, and who testify, under oath, of the necessity 
of placing him or her under the restraint of an asylum. 
The person applying for the admission of the patient must 
also sign a responsible bond, setting forth their reasons for 
the request, giving a history of the patient's symptoms and 
probable cause of the attack. The physicians who sign the 



33^ MEDICAL JURISPRUDENCE. 

certificate must have no connection with the hospital, nor 
be related by blood or marriage to the patient. 

Before certifying to the insanity of a patient under any 
circumstances, the physician should first conscientiously 
determine the fact of the insanity; and, for this purpose, 
he is compelled to make a careful personal examination of 
the patient. This may require several visits in some cases, 
since the cunning of the lunatic may at first baffle the phy- 
sician. Then as to the " setting forth the facts " upon which 
the physician's opinion is based, great care and experience 
are required, in order to give only such " facts " as are 
really demonstrative of the alleged mental disorder. 

3. In the discharge of lunatics the same caution and 
judgment are required on the part of the physician. 
Patients sometimes obtain their discharge from an asylum, 
contrary to the wishes of the superintendent, on a writ of 
habeas corpus, and they not infrequently bring an action 
against both the superintendent and the physicians who 
signed the certificate for false detention. But generally 
they are removed by their friends, when sufiiciently recov- 
ered, at the discretion of the superintendent. In this 
country there is no legal restriction on the liberation of the 
insane on their recovery, except in cases of homicidal, or 
otherwise dangerous, lunatics who have been confined by 
order of the courts. 

4. Medical men are often called upon to give evidence as 
to the existence, or not, of insanity in a criminal under 
sentence of death, in order to stay execution. For this 
purpose it is usual for the court to appoint a commission of 
three or more persons, the majority experienced physicians, 
to determine the question. 

5. When a defense of the prisoner is based upon alleged 



INSANITY. 337 

insanity, the court summons experts, whose duty it is to 
determine, as far as possible, the patient's mental condition 
both before and at the time of the commission of the crime. 
6. In civil cases the physician is constantly appealed to, 
as, e. g., to determine the testamentary capacity of one 
making a will, or signing a contract, or contracting a mar- 
riage, or transacting ordinary business. As regards testa- 
mentary capacity, it is understood that the law requires 
a less amount of mental capacity for making a will than 
for managing property or enjoying personal liberty. Pa- 
tients in asylums have made wills which the courts have 
sustained. Patients with insane delusions that did not 
affect the provisions of the will, and which were just and 
reasonable, have been held by the highest tribunals to have 
made good wills. Thus, a person suffering from religious 
melancholia, under the delusion that he had committed the 
unpardonable sin, but manifesting mental soundness in other 
respects, as indicated by his correct business transactions, 
undoubtedly is possessed of testamentary capacity. His in- 
sane delusion does in no wise affect the matter at issue — viz., 
his ability to dispose of his property. But it would be alto- 
gether different if his delusions took a different shape ; if, 
for example, be believed that one of his children had at- 
tempted to poison him, and, in consequence of this false 
notion, he had disinherited that child ; in such a case — inas- 
much as the delusion may have directly affected the pro- 
visions of the will — they should be regarded as impeaching 
the testamentary capacity. Under such conditions he could 
not be considered as possessing a disposing mind. The 
most absurd and eccentric wills have been held by the courts 
to be valid, where such wills were shown to be in perfect 
30 



33^ MEDICAL JURISPRUDENCie. 

accordance with the whole former Ufe and character of the 
eccentric (but not insane) testator. 

In order to make a vaUd will, the law requires that the 
testator should be sane at the time he makes it. Hence, 
temporary drunkenness, the delirium of a fever, narcotism, 
and similar conditions would, for the time, disqualify him. 
But a person may be suffering from the effects of a powerful 
poison — arsenic or strychnine, for instance; provided his 
brain is not affected so that his intelligence is impaired, 
his will made under these circumstances will be perfectly 
valid. The question has been raised of the validity of a 
will made by a person suffering from typhoid fever ; the 
answer should certainly be affirmative, provided he was not 
delirious at the time. In an English case it was held that 
neither erysipelas nor fever would invalidate a will, but that 
the stupor and drowsiness induced by them would. 

As regards paralysis, it has been settled that this is not 
sufficient to invalidate a will, even if it be accompanied with 
aphasia or loss of speech, always provided the mental 
powers were good. The same is true of the collapse of 
cholera, where the patient is unable to speak from exhaus- 
tion, but where the mental powers continue unimpaired. 

In epilepsy, unless it can be proved that the repeated 
attacks have affected the mind, so as to have completely 
unhinged it, it has been decided that the patient has a per- 
fect testamentary capacity in the intervals between the 
paroxysms. The case of the Duchess of Manchester (1854) 
is one in point. She executed a second will about three 
weeks before her death. She had repeated attacks of hys- 
teria and convulsions along with delusions. The attending 
physician deposed that on the day of executing the will, and 
for some days previous, the duchess had recovered her rea- 



INSANITY. 339 

son, and that at the time of signing- it she was, in his judg- 
ment, aware of what she was doing, and that she voluntarily 
delivered it as her own act and deed. It appeared also that 
the disputed will was substantially such as the duchess had 
announced before that it was her intention to make. At the 
trial several medical witnesses give their opinion that the 
duchess was of unsound mind, and, therefore, incapable of 
making a will. But the point at issue was — Was she at the 
time of executing the will in a competent state of mind ? The 
jury found that she was competent, and that the will was 
valid. 

When a physician is asked to examine into the testa- 
mentary capacity of a patient before executing his will, it 
will be well that the interview should be strictly private, or 
else in the presence of the nurse, or some one member of 
the family, in order to ascertain the true condition of his 
mind : whether it is free from the action of drink or nar- 
cotics ; whether he properly understands the nature of the 
act he is to perform ; whether he is influenced as to the 
manner of doing it by any insane delusions prompting him 
thereto; and, finally, whether any undue influence is being 
exerted over him from without. It may happen that in a 
private interview a dying man might disclose to his physi- 
cian the fact of such an improper influence, from which he 
was desirous of escaping, but which had become dominant 
over him in consequence of his weakness. 

7. The medical man may be asked his opinion in refer- 
ence to the propriety of contracting a marriage with a party 
who has been insane or who has an insane heredity. This 
is often a most delicate and responsible position for him to 
occupy. Undoubtedly, physicians will be generally averse 
to marriage when either party has been insane; certainly. 



340 MEDICAL JURISPRUDENCE. 

if there exists a history of insanity in the family, the risk 
is very great. A sporadic case of insanity, depending on 
some special cause and perfectly curable, may occur in any 
family ; this might be excepted from the advice above given. 
8. Then, also, as to the proper training and education of 
children of insane or neurotic parents, medical advice is 
often very properly sought and followed. Such children 
should, of course, be brought up on strictly physiologic 
and hygienic principles. Pure air, simple but nourishing 
diet, plenty of outdoor exercise, the avoidance of all im- 
proper excitement, especially toward the period of puberty, 
and the subordination of their intellectual studies to their 
physical health — these are the points to which the attention 
should be specially directed. 

CRIMINAL RESPONSIBILITY — THE PLEA OF INSANITY 
AS A BAR TO CAPITAL PUNISHMENT 

There is no aspect of insanity of more profound interest 
to the medical jurist, nor of greater importance both to him 
and to the community, than that of responsibility in crim- 
inal cases. After clearing away much irrelevant matter 
that prevents a clear comprehension of the subject of crim- 
inal responsibility — divesting it of all its mere technicalities 
and subtleties — we come to the true test — mental disturb- 
ance arising from disease. In the words of Dr. Bucknill : 
" The element of disease, therefore, in abnormal conditions 
of mind, is the touchstone of irresponsibility, and the detec- 
tion of its existence or non-existence is the peculiar, and 
oftentimes the difficult, task of the psychopathist." 

But the question immediately occurs — How is the exis- 
tence of this alleged mental disorder to be determined? 
What are the tests of its presence in the criminal at the bar 



INSANITY. 341 

of justice ? In England, formerly, the doctrine was " that 
every man was responsible for his acts unless he was totally 
deprived of his understanding and memory, and did not 
know what he was doing, no more than an infant, than a 
brute, or a wild beast." In the case of Bellingham, '' the 
knowledge of right and wrong " in the abstract was the 
test of mental unsoundness ; and as, in the opinion of the 
judge and jury, he was held to be capable of solving this 
metaphysical problem, Bellingham was duly hanged. Since 
the trial and acquittal of MacNaughton for the murder of 
Mr. Drummond, on the ground of insanity, the doctrine of 
the knowledge of abstract right and wrong has been changed 
to a knowledge of right and wrong in relation to the par- 
ticular act of which the person is accused, and also at the 
time of committing it (Husband). But a step further has 
been taken in declaring " he must also have a knowledge 
of the consequences of the act." 

The knowledge of the difference between right and 
wrong has been the test for years ; yet it is unsatisfactory. 
No doubt many insane persons have committed acts which 
they knew to be wrong, and of the criminality of which 
they were at the time perfectly conscious ; as they were 
also of their penal consequences. Some have been known 
to commit murder with the avowed intention of receiving 
the punishment of death at the hands of the law, instead 
of inflicting it suicidally upon themselves. Dr. Maudsley 
criticises the above " test " very truly when he says : " Here 
is an unhesitating assumption that a man having an insane 
delusion has the power to think and act in regard to it 
reasonably ; that he is, in fact, bound to be reasonable in his 
unreason, sane in his insanity." 

The decisions in the American courts have generally 



342 MEDICAL JURISPRUDENCE. 

been similar to those of England, the dominant idea being 
a knowledge on the part of the criminal of the wrong nature 
of the act in question — " its criminality, not only against 
the laws of man, but also against the laws of God and 
nature." The doctrine laid down by Mittermaier is thought 
by some to cover the ground more completely. He re- 
gards the will as the most important factor in the case. 
He rebukes the English jurists for their rigid adherence to 
the antiquated doctrine, that whoever can distinguish good 
from evil enjoys freedom of will, and retains the faculty (if 
he choose to use it) of framing his action to the requirements 
of the lav\^. " A person who commits a criminal act, being 
fully cognizant of the nature of the law, and of the punish- 
ment to which he is exposing himself, may yet be of insane 
mind. The true test of irresponsibility should be, not 
whether the party accused was aware of the criminality of 
his action, but whether he has lost all power of control 
over his actions." According to Hamilton, " the true test 
after all, is the condition of the will." With this Ordro- 
naux substantially agrees when, speaking of criminal re- 
sponsibility, he adds, in addition to the defendant knowing 
the nature and consequences of the act, and having a 
felonious intent in its commission, that " he had the power 
to choose between doing and not doing it; and, supposing 
this power to be lost, it is lost solely through disease, and 
not through temporary inebriety or violent anger." 

The above doctrine seems to be sound ; it is founded on 
psychologic principles, and certainly cannot be accused of 
bearing harshly or inhumanly against a prisoner. It places 
his irresponsibility for the criminal act exactly where it 
ought to be placed — on a distorted mind. Moreover, a 
thorough understanding of these views by medical experts, 



INSANITY. 343 

and a more general dissemination through the community of 
the important doctrine that insanity is a disease, and not a 
mere outburst of anger, or even a series of emotional acts, 
will contribute not a little to educate the people as to the 
reasonable and proper grounds to be taken in those cases 
of homicide in which the plea of insanity is urged. 

Impulsive or emotional insanity, as it is named, is often 
urged as a defense for crime, especially homicide. Is the 
plea a sound one? Can it be possible that an individual 
can be sane immediately before and immediately after the 
commission of an act, and insane only at the moment of its 
commission? A well-known writer thus expresses himself: 
" I see no ground on which to rest a hypothesis of an im- 
pulsive insanity, or to justify an incorporation in our medical 
jurisprudence of such a form. I cannot conceive of a 
homicidal act, impulsive without motive, delusion, or pas- 
sion, simply a so-called impulse to kill ; and a careful 
analysis of clinical cases under my own observation, as well 
as a large experience in the examination of criminals, sus- 
tains this view. Impulsive disease can not exist. The term 
impulse, used to describe certain acts of the insane, exe- 
cuted suddenly and without apparent premeditation, may 
be proper enough as qualifying a mental state during an 
act, as impulsive homicide, but this does not justify the 
transposition into homicidal impulse. Such transposition 
would show, not that the acts were apparently unpremedi- 
tated and sudden, but that, in the mind there was suddenly 
generated a murderous impulse, an irresistible power, which, 
without the intervention of reason, or any intellectual act 
or motive, suddenly impels to the physical act. Man is 
not the prey to blind impulse." (Quoted by Hamilton.) 



344 MEDICAL JURISPRUDENCE. 

SIMULATED OR FEIGNED INSANITY. 

There is probably no subject in medico-legal practice 
which causes the physician more trouble and anxiety than 
the disputed mental condition of an individual. If the ques- 
tion of feigned bodily diseases often occasions considerable 
difficulties, how much greater will be his perplexity and 
doubt when he comes to deal with the subtle workings of 
the mental operations. Insanity is not infrequently pre- 
tended by persons accused of criminal offenses, in order to 
procure an acquittal, or a discharge from prison. In the 
first place, when feigning is suspected, we should ascertain 
whether there was a motive for pretending to be insane. 
Remember that insanity is rarely, if ever, assumed until after 
the commission of a crime and the detection of the criminal. 

A further important point is, to ascertain if the criminal 
deed was, or was not, an isolated act in the mental life of 
the culprit — whether it originated suddenly in his mind, 
like a flash of lightning from an unclouded sky, or 
'' whether it was not rather the last link of a long chain 
of sinful, criminal desires, hopes, and acts." In other 
words, to ascertain if it was not just such an act as might 
have been expected from the culprit. This investigation is 
of the utmost importance, since it does not usually happen 
that a person should suddenly act in a manner diametrically 
opposite to all his former character, without some powerful 
psychologic cause. 

This inquiry into motive is often of primary importance 
in the alleged insanity of criminals. The motiveless char- 
acter of a deed is very apt to impress us with a lack of good 
sense, if not of positive mental weakness, in its author. 
Hence, if we can discover a true motive for a criminal act, 



INSANITY. 345 

especially if the motive agrees with the disposition and 
character of the culprit (an important consideration), this 
would go very far to establish the responsibility of the 
accused at the time of the commission of the crime, despite 
all his affectation of insanity. 

There is often great difficulty in getting at this motive. 
In some cases there is no apparent motive ; but we should 
not be too ready to admit its absence, since it is indisput- 
ably true that there are as many different motives to illegal 
action as there are different characters ; and what would be 
a powerful motive to one person might have no influence 
whatever over another, placed under different surroundings. 
" In order to recognize this fact, the inquirer must, in every 
case, place himself in the position of the culprit, and divest 
himself of his own ideas." . . . '' No crime, be it what 
it may, is ever committed without a motive ; and the char- 
acter of that motive may be expressed thus : ' the conscious 
impulse to the illegal gratification of a selfish desire ' " 
(Casper). 

A third point in the detection of feigned insanity is to 
ascertain whether the culprit, in carrying out the deed of 
which he is accused, has acted according to any regular 
plan or not. In most cases, however, this is of but little 
diagnostic value, since many confirmed lunatics evince the 
most surprising adroitness in planning and executing 
schemes for escape, or for enticing their victims whom they 
intend to murder. 

One thing, however, should be remembered in this con- 
nection : generally speaking, in a case of real insanity the 
individual will, so to speak, break down before he is quite 
through ; that is, he will do or say something which will 
betray his mental debility. Thus, an insane patient in a 



34^ MEDICAL JURISPRUDENCE. 

private asylum near London, with the greatest artfulness 
managed to steal a piece of iron, with which he subsequently 
sawed through the bars of his windows, and brought to 
success his long-cherished plan of flight. These circum- 
stances proved the calmest and most systematic deliberate- 
ness. But here his reason forsook him: after his escape, 
he ran straight to the Duke of Wellington's house, and 
announced himself as his eldest son. 

A fourth point to be noticed in the diagnosis of a case of 
pretended insanity is, whether the culprit has taken any 
measures to avoid arrest or punishment. Whether, for 
instance, he had adopted any disguise in his personal ap- 
pearance or dress, such as removing his beard or putting 
on a false one, dyeing his hair, etc., or making preparations 
for escape, or waiting for the darkness of the night for the 
perpetration of the deed. All such circumstances would 
create a strong suspicion that the accused pretty clearly 
recognized the responsibility of the deed. The really irre- 
sponsible criminal will usually evince a total apathy about 
the result, and will display a feeling of the utmost security, 
often exulting in the deed, which may even have been com- 
mitted against one of his own immediate family. 

A fifth important consideration in relation to the diagnosis 
is the peculiar condition of the intelligence of the accused 
as ascertained, on examination, to have always existed, or 
at least for a long time previous to the commission of the 
criminal act (Casper). For example, a person may be 
claimed as insane, because of alleged feeble-mindedness, as 
displayed in inability to count, to read and write, to carry 
on a continued conversation, and the like ; but all this may 
be satisfactorily answered by showing that the person has 
had no previous education whatever, and consequently no 



INSANITY. 347 

opportunity of learning any of the above matters. Hence 
the allegation of his being " silly," " childish," " simple," 
etc., can be of no avail as producing irresponsibility for his 
particular crime. Here the related facts must be ascertained 
in reference to the case in question — his family history, his 
mode of bringing up, his manner of life, etc., together with 
the relation of the deed for which he is accused to the 
sphere of his intelligence. 

Another point to be noticed is the distinction between 
the hallucinations of the really insane and the alleged 
" voices " and " impulses " of the pretender, forcing him on 
to the commission of his crime. It may safely be asserted 
that, whenever hallucinations accompany real insanity, the 
latter will display itself by other unmistakable signs, so that 
by attentive watching we can generally succeed in distin- 
guishing the genuine from the pretended. 

A strong circumstance bearing on the detection of sus- 
pected insanity is the fact that, in a genuine case of the 
disease, the person will not admit that he is insane ; while 
the pretender will use all his efforts to make you believe he 
is mad. So thoroughly is this the case that an impostor 
may be induced to perform any act, if it be casually ob- 
served to another in his hearing that the performance of 
such an act would furnish strong evidence of his insanity. 

Mania is probably more frequently feigned than any other 
form of insanity, from the popular notion that insanity is 
made up of violent action and vociferous and incoherent 
language. But mania seldom comes on suddenly without 
some obvious cause. A maniacal patient is equally furious 
by night and by day ; an impostor sleeps. Real mania 
manifests itself equally when the patient is alone or in com- 
pany ; an impostor, only when he thinks he is observed. 



34^ MEDICAL JURISPRUDENCE. 

The peculiar restless expression of the eye of mania is hard 
to imitate. The pulse, temperature, state of skin, etc., of 
the genuine disorder cannot be assumed by the impostor. 
Dementia is more difficult to imitate. The discovery of 
any connected ideas, reasoning, or reflection, either by lan- 
guage, signs, or writing, would immediately show that the 
patient was simulating. 

Occasional instances, however, are presented of a suc- 
cessful malingering in this line which baffle the detective 
skill of the most experienced examiners. Dr. Bucknill 
mentions the case of Warner, a notorious thief, who was 
sentenced to transportation for fourteen years. Two days 
after the trial he became apparently insane ; he constantly 
made howling noises, was filthy in his habits, tore up his 
clothes, destroyed his bedding and other articles. He was, 
however, suspected of shamming and was detained in prison 
for three months. During part of this time it was found 
necessary to keep him in a straight waistcoat. At length 
a certificate of insanity was forwarded "to the Secretary of 
State, and he was ordered to be removed to the Devon 
County Asylum. On admission here he was found to be 
in feeble health. He had an oppressed and stupid expres- 
sion of face; he answered no questions, but was constantly 
muttering to himself, remaining in the same position for 
hours, either in a standing or sitting posture. He was now 
not dirty in his habits ; he appeared to be, in truth, suffering 
from acute dementia. In three weeks' time he recovered 
his bodily health. This change was too rapid not to suggest 
the idea of deception, but the preceding symptoms had 
been so true to nature that it was still thought that the 
insanity had not been feigned. For a period of eight months 
he was well conducted and industrious and he showed no 



INSANITY. 349 

symptoms of insanity. At the end of that time he was re- 
turned to the jail to undergo his sentence, and within one 
hour after his readmission within its portals he was appar- 
ently afflicted with a relapse of his insanity. From this 
time, for a period of two years, this indomitable man per- 
sisted in simulating mental derangement. He refused to 
answer questions, walking to and fro, constantly howling, 
and refusing food for days together. He would keep beat- 
ing at the door of- his cell, tearing up his bed-clothes over and 
over again ; he had a stupid expression of countenance, but 
he slept soundly. He became filthy in his habits, but was 
cured of this by the hot bath. He was often visited by the 
physician, who said he was a malingerer. After two years 
he suddenly gave up and acknowledged the deception. 



CHAPTER XIV. 
MALPRACTICE. 

Malpractice (or malpraxis), may be defined to be bad or 
wrong practice — bad or wrong in its results, whether these 
be loss of limb by amputation, deformity, serious injury to 
health, or even death. 

The responsibility of physicians has ever been a fruitful 
theme for discussion. It is comparatively rare that the sub- 
ject becomes the source of a criminal prosecution, except in 
cases of feticide resulting in the death of the mother; but 
actions for damages before the civil courts, often for large 
amounts, are alarmingly frequent, and may well call upon 
the medical men to consider what their exact legal standing 
is in this matter, and what protection they are entitled to 
claim from the law, when thus assailed. 

In the first place, it should be clearly understood that 
the physician or surgeon, when called to treat a case of 
disease or injury, does not become an insurer or guarantor 
to cure, any more than an attorney obligates himself to win 
the case for his client. In both instances, the professional 
man merely undertakes to do his best — " to bring to the 
exercise of his profession a reasonable, fair, and competent 
degree of skill." The medical man should always beware 
of compromising himself by a promise to cure his patient; 
if, however, he be so unwise as to have made such a con- 
tract, he will be held by the law strictly accountable for its 
performance. In case of failure, it will be no defense for 
him to allege the occurrence of unforeseen contingencies, — 

350 



MALPRACTICE. 3 5 I 

these he was bound to have knowledge of. Neither may 
he allege a want of sufficient skill or dexterity; these he is 
supposed by the law to possess when he undertook the case. 
Thus, if a surgeon contracts to cure a patient of deformity 
by the removal of a limb, and death ensues through pyemia 
or erysipelas, he will be held liable for forfeiture of his con- 
tract. Of if he undertakes, by contract, to cure a woman 
of an abdominal tumor by the operation of ovariotomy, and 
death results through an unavoidable peritonitis, this will 
not excuse him. So, likewise, a lawyer contracting for the 
foreclosure of a mortgage will be held liable to his client, 
in case of failure on his part. In all these instances, the con- 
tract will bind the parties. Their fault and folly was to have 
undertaken what was beyond their capacity to perform. 

In all ordinary cases, where there is no express stipula- 
tion between the parties, the medical man impliedly agrees 
to bring his best skill and endeavors to cure the patient. 
Formerly, the law made a distinction between a fatal issue 
following the treatment of the regular physician and that 
of the quack, regarding the former as only a " misadven- 
ture," but punishing the latter as manslaughter. At present, 
both in the United States and Great Britain, this distinction 
has been abandoned, the court regarding all systems of 
medicine as being entirely on a par, so that, if the practi- 
tioner announces himself, or herself, as belonging to any 
particular school or system of medicine, and practicing as 
such, the patient who employs such a practitioner, and 
suffers thereby either in limb or life, has no legal redress; 
he has made his election, and must abide the consequences. 
Indeed, it would appear that the charlatan is, under the 
present system of law, much more likely to escape in a suit 
for malpractice, than the most experienced regular physician. 



352 MEDICAL JURISPRUDENCE. 

It may not be always easy to determine just what " the 
ordinary degree of skill " used by law authorities means, 
since what might be regarded as an ordinary degree of skill 
in a large city, or center of medical learning, would prob- 
ably be considered by the untaught and inexperienced resi- 
dents on the frontiers of civilization as very extraordinary 
skill, and vice versa. Consequently, this term, " ordinary 
skill," must have a varied latitude of application, according 
to the circumstances of individual cases. 

The following principles may be regarded as established, 
being founded on various judicial decisions, both in this 
country and in England : — 

I. If the practitioner acted honestly, and used his best 
skill to cure, and it does not appear that he thrust himself 
in the place of a more competent person, it makes no differ- 
ence whether he was, at the time, a regular or an irregular 
physician or surgeon. This principle has been stretched 
to its utmost limits, even where death has unquestionably 
resulted from the practice of notorious quacks, such as St. 
John Long and Samuel Thompson, although the grossest 
ignorance was proven against both of them. In the case in 
which an ignorant old man practicing obstetrics, on one 
occasion mistook a prolapsed uterus for a placenta, and tore 
it away by main force, causing fatal hemorrhage. Lord 
Ellenborough, C. J., charged that '' there was not a particle 
of evidence to convict the prisoner of the crime of murder." 
The prisoner was acquitted. This case illustrates, as Elwell 
justly remarks, how ignorant a Lord Chief Justice of Eng- 
land may be as to the science of medicine. He appeared 
to suppose that because an ignorant old man had the 
temerity to act the part of an obstetrician among a class 
of ignorant women, that therefore he must necessarily have 



MALPRACTICE. 353 

some skill — a most absurd proposition. " It no more inferred 
' some degree of skill ' in the prisoner, because he had de- 
livered some women successfully before, than the fact that a 
woman who has delivered herself of ten or a dozen children, 
which is often the case, is evidence that she possesses some 
knowledge of the uterine system." Unquestionably, such 
a lack of anatomic knowledge as would cause a man 
to mistake a uterus for a placenta should be classed as the 
grossest ignorance, and should subject the pretender to 
severe punishment. 

II. Not only ordinary skill, but ordinary care and atten- 
tion to the patient are required of the attending practitioner. 
If a surgeon, for example, after skillfully performing an 
operation, neglects the after-treatment, such as proper dress- 
ing and bandaging, and, in consequence thereof, hemor- 
rhage, pyemia, mortification, or deformity should result, he 
will be justly held responsible in an action for malpractice. 
In every such case, however, if the defendant can clearly 
prove these two points — an average amount of skill and com- 
petency, together with a proper degree of careful attention 
on his part — he may feel certain of an acquittal, unless 
the trial should happen to be before a stupid jury and a 
prejudiced judge. 

III. As medical men are not infallible, the most skillful 
may err in judgment in advising a particular remedy, about 
which there is a difference of opinion. An error of judg- 
ment made by such a practitioner is clearly excusable. 
Lord Mansfield, speaking of attorneys, says : " Every man 
is liable to errors, and I should be very sorry to think that 
it should be taken for granted that an attorney is answerable 
for every error or mistake, and to be punished for it by 
being charged with the debt he was employed to recover " 

31 



354 MEDICAL JURISPRUDENCE. 

and Judge Porter remarks that the agent is not responsible 
" if the error was one into which a prudent man might have 
fallen. The contrary doctrine seems to suppose the posses- 
sion, and requires the exercise of perfect wisdom. No man 
would undertake to render a service to another on such 
severe condition." 

If, however, an unusual and violent remedy has been 
administered by a person grossly ignorant of medicine, and 
this medicine has caused death, if the individual is of average 
mental capacity he should be held criminally responsible, 
since such a course would seem to imply malice on his 
part. 

According to the civil law, when the practice of the 
attending physician or surgeon is called in question, the 
prosecution must show, first that the injury to the health 
or body of the patient actually resulted from the bad treat- 
ment of the practitioner ; and, secondly, that this evil result 
might certainly have been foreseen and avoided by a 
competent medical attendant. " Malpractice can only be 
affirmed when the practitioner has set aside established prin- 
ciples, and neglected to employ means which are universally 
held to be necessary in the given case." But before guilt 
can be established on any such derivation it must be shown 
(i) that the following out of the rules usually prescribed 
by medical science for the cure of disease never proves detri- 
mental ; (2) that there is at least the greatest probability 
that the observing of the rules would accomplish the desired 
end; and (3) that the great majority of medical men ap- 
prove the rules. 

IV. The almost universal adoption by modern surgeons 
and gynecologists of antiseptic or aseptic methods in their 
practice might be likely to raise the question of malpractice 



MALPRACTICE. 355 

in a case in which fatal results had followed an operation in 
which antisepsis had been neglected. The possibility of 
such a contingency should, we think, serve as a sufficient 
warning to the operator not to neglect such precautionary 
measures. 

V. A medical man cannot be held guilty of criminal care- 
lessness for failing to employ any particular remedy, since 
there is never any one remedy upon which all authorities 
are agreed ; and since it is always possible that the patient 
may recover without the use of such remedy. If it could 
be shown that there existed a specific remedy for any dis- 
ease, then a neglect to use such remedy, on the part of the 
physician, would be criminal, and be punished as such. 
The uncertainty of remedies must necessarily allow a large 
latitude in their selection and employment; and this uncer- 
tainty even affects, to some limited extent, the use of anti- 
dotes in cases of poisoning. But where it can be shown 
that a physician called to treat a case of poisoning failed to 
administer the universally accepted antidote, he should be 
held guilty of criminal carelessness, as, e. g., albumin, in case 
of corrosive sublimate poisoning. 

Casper goes further than this, and asserts that " a physi- 
cian should be held liable to punishment if, in a given case, 
he departs entirely from the treatment which the great 
majority of physicians of his time adopt, and which the 
great majority of medical authorities recommend in such 
cases." But great difficulty would unavoidably result from 
adhering to such a rule ; it might often be impossible for 
the physician to stop to inquire, in any given case, what 
was the practice of the majority of his contemporaries. 
Besides, this principle would render all homeopaths, eclec- 
tics, botanies, etc., liable to punishment. 



35^ MEDICAL JURISPRUDENCE. 

In consequence of these doubts, the modern practice in 
the United States is that when a physician announces him- 
self as practising under some particular system, as the 
homeopathic, eclectic, or botanic, and is employed by per- 
sons knowing that this is the case, he is, at least, not crimi- 
nally responsible to them, in the even of serious results, 
because his views do not accord with those of what are 
called regular practitioners. While the law prescribes no 
one absolute system of medicine, a practitioner is expected 
to practice according to the system he professes and avows ; 
a departure from this system, if accompanied with some 
serious or fatal mistake of remedy, would render him justly 
amenable to a criminal charge. Hence a regular practi- 
tioner, and one employed as such, if he should surrepti- 
tiously, and without the patient's consent, use homeopathic 
or botanic treatment, to the detriment of his patient, would 
clearly be liable for damages to the latter; and, moreover, 
he could not recover his compensation for attendance, in a 
suit at law, because he had departed from his avowed 
system of practice. For the same reason a homeopathic or 
botanic physician, practicing either of these systems avow- 
edly, if he should have employed the regular system, instead 
of his own, and his patient failed to make a good recovery, 
would equally be held liable for damages, and would equally 
be exposed to a non-suit in an attempt to collect his fee, in 
a civil court. 

The civil suits for alleged malpractice far outnumber the 
criminal actions. As already observed, the former are so 
alarmingly frequent as to occasion a general distrust, par- 
ticularly among surgeons. A large number of such suits 
are brought evidently for the purpose of blackmail — plaintiff 
being usually in league with some lawyer, with whom he 



MALPRACTICE. 357 

has agreed to share the fees ; and he resorts to this practice 
as a convenient mode of discharging his doctor's bill. 
Generally speaking, the discrimination of the court is ade- 
quate to detect and expose the fraud, even to a jury, which 
is often too ready to side with the plaintiff in a trial of this 
nature. 

It is a question whether a slight deviation from the ordi- 
nary modes of performing operations should involve a 
charge of malpraxis. Taylor refers to a remarkable case 
occurring in this country, in which an action was brought 
and damages recovered against a physician for alleged neg- 
ligence in vaccinating a young woman. Some inflamma- 
tion followed the operation, which, it was asserted, was 
performed nearer the elbow joint than usual. The judge, 
singularly enough, ruled that '' the physician is liable for 
all the bad consequences resulting from vaccination or 
inoculation, if he fails to insert the virus in that part of the 
arm usually selected for the purpose, notwithstanding many 
other parts of the body might be proved to be equally 
proper and even more suitable locations !" Taylor calls 
this " a very singular specimen of transatlantic jurispru- 
dence." 

Gratuitous service on the part of the practitioner will not 
exempt him from an action for malpractice, if either ignor- 
ance or carelessness in his attendance can be proven against 
him. 

A patient who refuses to cooperate with his medical 
attendant, and who thereby sustains injury, cannot recover 
compensation for the injury, unless the latter is clearly 
traceable to the attendant's malpractice. 

It has lately been decided that when a physician took 
with him, without necessity, to a case of confinement, a 



358 MEDICAL JURISPRUDENCE. 

young unmarried man not a physician nor student of medi- 
cine, and the fact of his not being a medical man was 
unknown to the patient or her husband, both the physician 
and the attendant were Uable for damages. 

There is another source of HabiHty to an action for mal- 
practice, which is not generally alluded to, but which from 
its gravity certainly deserves notice — viz., inebriety. Most 
assuredly, if a physician or a surgeon, when inebriated, 
undertakes to prescribe for a patient, or to operate upon 
him, he places the latter in serious and possibly fatal 
jeopardy ; and for this he should undoubtedly be held re- 
sponsible. Many States have enacted statutory laws upon 
this subject. These laws vary somewhat in the severity of 
the punishment annexed to the offense. 

It is worth while noting that it has been decided by one 
of the courts that to enable a physician to recover, by suit, 
fees for services, the record of such services must be kept 
in an intelligent form and in a regular book. Cabalistic 
signs indicating visits, office consultations, etc., are not evi- 
dence. 

The liability of druggists rests practically upon the same 
principles that govern physicians. Ignorance and careless- 
ness in putting up prescriptions, whereby gross or even 
fatal mistakes may occur, should justly render them liable 
to an action at law. So, likewise, the entrusting the com- 
pounding or vending of medicines to careless clerks or 
inexperienced apprentices would entail criminal responsi- 
bility upon the principal. 

There is a special law in some States in relation to the 
selling of poisons by the apothecary without a physician's 
prescription ; and also regarding the proper labeling of the 
same before sending them away. 



MALPRACTICE. 359 

One authority states : '* Druggists, like physicians, come 
under the laws governing specialists. They are bound to 
know — expected to know — the kinds and natures of the 
medicines with which they deal. ... If an apothecary 
administers improper medicines, the law holds him liable, 
although his contract is with a third person." 

Another authority says : " A druggist deals in things 
certain — things which his eyes can see and his hands can 
handle. He, like the physician, is liable for ordinary care 
and skill ; and it is only ordinary for a druggist to know of 
every medicine in his shop and to have his medicines in 
their proper places and properly labeled." 

A few States have legislated in relation to the mistakes 
made by druggists and their clerks in the compounding of 
prescriptions, the penalties affixed being regulated by the 
amount of damage done ; if death resulted, it is regarded as 
a felony and punished by a heavy fine and imprisonment. 
Doubtless, however, the punishment would be much milder, 
provided the culprit could prove a previous good character 
as to '' competency and skill," and that he has come fully 
up to what the law terms, '' a duly qualified assistant." In 
the latter case, his mistake, even though attended with fatal 
consequences, would probably not be regarded legally as 
" culpable negligence," but would rather come under the 
head of *' excusable homicide/' or '' homicide by misadven- 
ture," where there was no evil intention on the part of the 
perpetrator, but where the mistake was made " under cir- 
cumstances of sudden confusion, which threw him off his 
guard." 

The means of diagnosis in certain classes of cases have 
been so materially increased by the introduction of X-ray 
methods that it is obvious that charges of malpractice may 



360 MEDICAL JURISPRUDENCE. 

now be easily sustained in cases in which in former years 
no such HabiHty would have been incurred. It is as yet 
uncertain, however, how far the courts will hold the appli- 
cation of these methods to be necessary, or admit the evi- 
dence that is thereby obtained. It is also obvious that the 
various tests for diagnostic purposes will, in time, be an im- 
portant factor in questions of malpractice, but nothing defi- 
nite can be given at present. 



CHAPTER XV. 
LIFE INSURANCE. 

Insurance on a Life is simply a contract whereby the 
company that insures, in consideration of a certain sum, 
payable in instalments and denominated a premium, agrees 
to pay a stipulated amount at the death to the heirs or to a 
designated person, or to the insured himself at some definite 
period of his life. The deed by which this contract is made 
is termed a policy. This policy contains many provisions 
and conditions, upon the proper construction of which legal 
disputes frequently arise. 

The amount of premium to be paid depends chiefly upon 
the age of the applicant, though also somewhat upon the 
sex and occupation. 

The amount insured for (if payable at death) cannot be 
recovered until distinct and satisfactory proof of death be 
furnished by the beneficiary of the policy. Upon this proof 
the companies insist with great positiveness, inasmuch as 
fraudulent insurances are frequently effected and the com- 
panies victimized. 

In case of mysterious disappearance of the insured, with 
no clew to his whereabouts, the law allows an interval of 
seven years to elapse (presumption of death) before pay- 
ment can be pressed; but it is usual for the company to 
make the payment much before this period, unless there is 
good reason to suspect fraud. This is especially true of 
persons going to sea, where the presumption of death may 
be settled sooner. Again, the question of survivorship 
32 361 



362 MEDICAL JURISPRUDENCE. 

may be raised, as when two or more persons perish by the 
same calamity — as by shipwreck — and one happens to be 
insured for the benefit of the other. 

Among the conditions of a poHcy, the most important 
one is the general health of the applicant, as influencing his 
expectation of life; and it is just here that medical science 
is always appealed to to decide upon the actual condition 
and the proclivities to disease through hereditary or other 
causes. The printed questions in the policy are both 
numerous and pointed, and they should be answered truth- 
fully, since the contract is equally binding upon the insured 
as upon the company ; and if it be subsequently discovered 
that any fraud has been perpetrated through misrepresenta- 
tion or concealment of facts in relation to disease or bad 
habits, the policy will be voidable and the premiums already 
paid forfeited. This is just and equitable; and no respect- 
able company refuses to pay the amount of a policy, unless 
there is a reasonable ground to suspect a willful fraud in 
the contract. 

Still, lawsuits occur very frequently in regard to life in- 
surance, and the contested points usually have reference to 
the significance of medical terms or phrases in the contract, 
such as " any other diseases or habits tending to shorten 
life," etc. It is surprising how often the applicants will 
prevaricate and dissimulate upon these last-named points, 
and especially upon their habits as regards the use of alco- 
holic drinks. Medical examiners for life insurance com- 
panies find it difficult to get clear and satisfactory answers 
in relation to the habits of the individual as regards the 
use of alcoholic beverages. Often will it be found that the 
man who is in the habit of taking three or four drinks 
of spirits daily will consider himself a perfectly temperate 



LIFE INSURANCE. 363 

men ; and, unless he is closely questioned and made to give 
distinct replies, he may be classed in the policy as strictly 
temperate, when all the while his health is undoubtedly 
being undermined and his expectation of life thereby 
shortened, although he cannot properly be classed as an 
inebriate. 

The suppression of a fact in relation to the health of the 
applicant, if not known by him, will not invalidate his policy. 
This was determined in a case in which Dr. Reese was an 
expert witness, decided on an appeal to the United States 
Supreme Court in 1880. Here, the main defense was that 
some of the answers to the interrogatories of the policy were 
not true, but that the insured was, at that time, actually 
suffering from certain alleged diseases mentioned in the 
contract. There was only one witness to support this allega- 
tion, a homeopathic physician, who had prescribed for the 
plaintiff thirteen years before '' for chronic asthma, mani- 
festations of the first stages of consumption, and scrofula." 
This witness, as it appears, never mentioned his suspicions 
to his patient, neither did he testify positively that the patient 
really had the diseases for which he treated him ; and", more- 
over, the testimony of the insured was that '* he never learned 
from him, nor from any other physician, nor had he ever 
suspected, nor had the remotest idea, that he was affected 
with any such diseases ; but, on the contrary, he always 
boasted of himself as being a strong, healthy, and robust 
man." Clearly, in such a case, the applicant should not be 
held responsible for the suppression of a fact of which he 
was utterly ignorant and of the very existence of which 
there was considerable doubt. 

In all cases the exact state of the applicant's bodily health 
should be ascertained, either by his answers to the written 



364 MEDICAL JURISPRUDENCE. 

categorical questions, or by oral questioning by the medical 
examiner. The case of the Duke of Saxe Gotha is cited as 
an illustration of the necessity of not concealing material 
facts. The applicant, while residing abroad, was insured in 
an English office for the sum of £3,000. The certificates 
of his two German medical examiners stated that his gen- 
eral health was good, although he had an impediment in 
his speech and an affection in one eye, but that he was 
perfectly free from disease or symptoms of disease. The 
facts were that the Duke had been suffering from cerebral 
disorders for over two years, that he was childish and could 
not speak. He died of paralysis within nine months after- 
ward and an autopsy disclosed a large tumor evidently of 
long standing, pressing upon the brain together with an 
effusion of ten ounces of serum. The plaintiff was non- 
suited. 

The question of intemperance in relation to the habits of 
the insured causes, probably, more discussion and difference 
of opinion in contested life-insurance cases than any other. 
It would seem almost impossible in such cases to define 
what intemperance is. An instance is mentioned by Taylor 
which illustrates the difficulty of getting at the truth. In 
this, payment was refused on the ground of concealed habits 
of intemperance. Twelve witnesses were called by the 
plaintiff to prove that the deceased was a very temperate 
man, while the office called twenty-one to show that he was 
habitually intemperate. The medical man who furnished 
the certificate stated that he considered it a perfectly safe 
risk; for, although he had occasional outbreaks, he did not 
think drinking had any bad effects upon his health. This 
case shows the differing views entertained by even medical 
men upon this subject. 



LIFE INSURANCE. 365 

While we must admit that there are a few exceptional 
cases of persons who are habitual moderate drinkers living 
to old age, and enjoying apparent uninterrupted health, we 
cannot be blind to the fact that habitual drinking does cer- 
tainly and gradually impair the health, including dropsy and 
organic disease of the stomach, liver, and kidneys, which 
unquestionably tend to shorten life. 

If a true representation of the temperate habits of the 
insured was made at the time of application, and he should 
subsequently fall into habits of intemperance, this would be 
no bar to a recovery upon the policy. In many of the 
modern policies the proviso against intemperance is omitted. 

The above general principles will serve also as a guide in 
cases of the opium or chloral habit. A concealment of the 
fact that the applicant was addicted to opium eating, even 
although it might be alleged that this habit had not im- 
paired his health, would undoubtedly be an obstacle to a 
recovery upon the policy. 

As regards the question whether insanity has a tendency 
to shorten life, and therefore whether the concealment of 
its existence in the applicant amounts to the concealment 
of a material fact, it may be said the almost uniform expe- 
rience of physicians is that it does tend to shorten Hfe. 
Moreover, there is in nearly every policy a direct question 
bearing upon this point, the company reserving to itself the 
right to reject the particular applicant thus affected. 

The relationship of suicide to life insurance is one of con- 
siderable interest, and has been the source of frequent liti- 
gations. The principle by which any particular case is to 
be decided is — Was the suicide evidently the result of in- 
sanity, and did this insanity come on after the policy was 
taken out? If so, then clearly the insured is entitled to 



366 MEDICAL JURISPRUDENCE. 

recover, just as much so as if the suicide was caused by the 
acute deHrium of a fever, or by inflammation of the brain. 
But if it can be shown that the suicide was the result of 
a deHberately formed purpose, with a motive sufficiently 
strong to impel to the act (such as to get rid of impending 
debts^ or to bestow the insurance money upon the indi- 
vidual's family), then there was no insanity connected with 
the act, and the policy should be void, because the insured 
had voluntarily shortened his life. In a doubtful case of 
this character, the turning-point would seem to be to deter- 
mine if the suicide could be traced to a perfectly intelligent 
motive. For example: It is credible that an individual 
pressed down by the burden of some enormous debt, which 
he has been vainly hoping to pay, and with the poverty and 
degradation of his family staring him in the face, should 
embrace a tempting offer to insure his life for an amount 
that will not only repay his indebtedness and rescue his 
name from dishonor, but at the same time save from poverty 
and want those whom he loves better than himself. Why 
should not the spirit of self-sacrifice be as dominant in such 
a one as in the embezzler who, to avoid the discovery of 
his frauds and the disgrace and punishment consequent 
thereupon, voluntarily takes his own life? A very suspi- 
cious circumstance in connection with these cases of suicide 
and life insurance is the fact that the deceased has rarely 
made more than one or two payments on his premium 
before committing the suicidal act. 

One of the most remarkable cases of this character, in 
which the question of suicide by strangulation was urged 
by the defense, is that of Col. Dwight, which was tried in 
Norwich, N. Y., in December, 1883. This gentleman had 
been involved in heavy pecuniary difficulties, through ex- 



LIFE INSURANCE. 367 

tensive financial operations. A few months before his death 
he eflfected insurances on his Hfe to the amount of three 
hundred thousand dollars, on which he had made one quar- 
ter's payment before he died. He had been complaining 
some weeks before of chills, loss of appetite, and sleepless- 
ness ; but on the day of his death he was comfortable, was 
up and dressed, saw company, and executed legal papers. 
About half-past eleven o'clock on that night he was heard 
to gasp for breath by his attendant, who was in an adjoin- 
ing room ; he immediately went to his aid, raising him up, 
and then summoned his wife and other friends ; death 
occurred almost immediately afterward. The question to 
determine was whether the deceased had strangled himself 
with a cord, or whether the death had resulted from an 
overdose of morphin, of which he had taken about three 
grains throughout that day by the advice of his physician. 
To support the theory of suicide by strangulation, several 
highly respectable physicians testified to the presence of 
one or more distinct depressions around the neck, having 
all the characters attendant on the usual marks of a con- 
stricting cord. These marks were attempted to be ex- 
plained away by attributing them to the folds of the skin of 
the neck due to the bending of the neck in the ice-box. 
But they were also noticed several months later, on the 
exhumation of the body. On the side of the plaintiflf, it 
was alleged that the death was due to heart exhaustion, 
precipitated by the overdose of morphin. No testimony, 
singular to say, was taken from the persons who were wit- 
nesses of the death, save the one who sat up with him, and 
this man said nothing about strangulation, but gave the 
idea of its being a natural death. The jury found for the 
plaintifif, thus ignoring the idea of a fraudulent suicide. The 



368 MEDICAL JURISPRUDENCE. 

insurance companies appealed, and after trials in several 
courts the case was compromised. 

A decision has been made by the United States Suprerne 
Court declaring that when a person of sound mind commits 
suicide the life insurance becomes void. 



CHAPTER XVI. 
TOXICOLOGY. 

Poisoning is probably the most frequent of all the causes 
of violent death, the casualties of war excepted. The fa- 
cility with which poisons may be procured, the ease with 
which they can be administered, and the close resemblance 
that the effects of many of them bear to disease in symp- 
toms and post-mortem lesions, will account for the fact of 
their extensive employment, both for homicidal and suicidal 
purposes. 

A poison may be defined to be a substance that when ab- 
sorbed into the system produces such a disturbance of func- 
tion as to imperil life. Mere mechanical action such as that 
produced by powdered glass would not be included by this 
definition, but be classified under traumatism. Whether 
or not a given substance acts as a poison depends, among 
other matters, upon the dose taken. Strychnin is uni- 
versally regarded as a poison, but in very small doses (^^^-^5^ 
grain) it may be taken daily for long periods without ap- 
parent injury and is, indeed, regarded as a tonic. 

According to the above definition, it matters not by what 
avenue a poison gains access into the body, its ultimate 
effects are the same. The stomach, of course, is the most 
usual means ; but the rectum, the skin, the lungs, and the 
cellular tissue by hypodermic injection, and even the nose, 
ear, and vagina, are also channels of entrance. Inhalation 
of poisonous vapors through the lungs, and the subcutane- 
ous introduction by the hypodermic syringe effect the system 

369 



370 TOXICOLOGY. 

far more rapidly than by swallowing, because of their more 
rapid absorption. 

Hydrogen sulphid (sulphuretted hydrogen) is a powerful 
poison when inhaled, but it may be introduced in consider- 
able amount into the rectum without unfavorable symptoms. 

The Effects of Poisons are local and remote. The local 
effects are the direct impressions produced on the part of 
the body with which the poison comes into contact — e. g., 
the corrosion of the stomach and bowels by the immediate 
contact of the mineral acids and alkalies. Often a poison 
may act both locally, by its causing inflammation of the 
stomach, and also remotely, on the brain and nervous sys- 
tem. 

The remote effects of a poison are those results which 
are produced on parts of the system remote from that to 
which it was first applied, as, e. g., the narcotic effects of 
opium on the brain, after being taken into the stomach. 
These remote effects constitute, in fact, the usual symp- 
toms of poisoning — a very important factor in the diagnosis 
of the case. 

Mode of Action on Poisons. — In order that a poison 
should produce its effects on the system, it is necessary 
that it should get into the circulation, so as to be conveyed 
to distant parts of the body ; and for this purpose it must 
first be absorbed. Although other modes of transfer of the 
poisonous impression to remote parts of the system have 
been at various times recognized, — such as nervous com- 
munication and contiguity of structure, — the present ac- 
cepted doctrine is that of absorption into the circulation. 
The so-called corrosives produce local actions that are gen- 
erally sufficient to produce death 



ACTION OF POISONS. 3/1 

The proofs of absorption are abundantly aflforded (i) by 
the detection of the known poisons in the blood ; (2) in the 
secretions, especially the urine; and (3) in the diflferent 
viscera of the body, as the liver, kidneys, lungs, spleen, 
brain, etc. An essential part of the toxicological examina- 
tion is to discover the poison, in the absorbed state, in the 
viscera. 

The rapidity of the absorption is remarkable. It has 
been shown that a poison injected hypodermically will be 
diffused through the circulation in a few seconds. A solu- 
tion of hydrogen sulphid injected into the rectum of a dog 
was eliminated by the lungs in sixty-five seconds. 

The rapidity of absorption is materially influenced ( i ) by 
the solubility of the poison ; so long as the substance is 
insoluble it cannot be absorbed, but many substances 
insoluble in water speedily dissolve in the fluids of the 
stomach and intestines, and so pass into the circulation. 
(2) By the nature of the surface to which it is applied, it 
being in direct ratio to the vascularity of the part. It is for 
this reason that the most rapid absorption is from the air- 
cells of the lungs, when the substance is inhaled in the form 
of vapor, and is immediately taken up by the very extended 
vascular pulmonary area. For this same reason, also, when 
it is injected directly into the blood-vessels, the effect is 
almost instantaneous. Christison injected conin hydro- 
chlorid into the femoral vein of a dog, and death took place 
in three or four seconds. Some animal poisons, such as 
the virus of glanders, syphilis, smallpox, etc., when swal- 
lowed, appear to undergo a change, through digestion, 
which renders them innocuous. The absorption of poisons 
in the stomach is modified by the condition of that organ 
— being most rapid when it is empty. The skin may be 



3/2 TOXICOLOGY. 

the avenue for the introduction of poisons, as witnessed in 
the absorption of arsenic, tartar emetic, corrosive subHmate, 
opium, etc., when applied in ointment or washes. By 
removing the cuticle, the absorption is much more rapid, 
as seen in the endermic method. (3) Fullness of the blood- 
vessels. The rapidity of absorption is inversely to the 
quantity of the circulating fluid; hence, depletion by bleed- 
ing or purging will favor absorption. 

But admitting the fact of absorption, the further question 
whether the fatal effects of the poison are to be ascribed to 
this, is answered affirmatively by showing that these effects 
continue so long as the circulation of the blood goes on 
between the point of insertion and the organs affected, and 
that they cease when the circulation is arrested. The oft- 
quoted experiment of Magendie establishes the first of these 
propositions. He divided all the tissues of a frog's leg 
except the blood-vessels, and inserted the foot into a solu- 
tion of nux vomica; absorption took place through the 
blood and fatal tetanic convulsions ensued. The same 
experiment repeated on a leg in which the blood-vessels 
only were divided (they interrupting the circulation), pro- 
duced no effect upon the animal. The second proposition is 
proved both by the foregoing experiment, and in the fol- 
lowing: Hydrogen cyanid was introduced into the stomach 
of a dog, through an opening in its walls. So long as the 
vessels passing from the stomach to the liver were secured 
by a ligature, no poisonous effects were produced ; but they 
were manifested within one minute of the removal of the 
ligature. 

Subsequent Disposition of the Poison. — After absorption 
into the blood, as the poison passes through the different 



DISPOSITION OF THE POISONS. 273 

organs, a portion of it is immediately separated by these, 
and at once eliminated by the various secretions, bile, urine, 
saliva, pancreatic fluid, and sweat. Another portion may 
be temporarily deposited in the organs and tissues, and 
usually in the following order as to quantity: the liver, 
spleen, kidneys, heart, lungs, brain, pancreas, muscles, and 
bones. To this order there may be occasional exceptions, 
as some recent experiments seem to prove that lead and 
certain other mineral poisons show an especial affinity for 
the spinal cord and brain. Only a minute quantity of the 
poison is circulating in the capillaries at any one time, yet 
there is good reason to believe that it is exclusively this 
small portion which is really noxious ; while still remaining 
in the stomach, or retained in the organs, it is harmless. 
Hence, it is a common mistake to attribute death to the 
actual quantity of the poison found in the stomach of the 
deceased; this is only the surplus, or complement, of what 
was necessary to kill. It has, in fact, no direct connection 
with the fatal result, this being caused by the absorbed 
portion only (except in the case of the corrosives, which 
act locally). Although that portion of the poison which is 
retained in the organs (absorbed) is, for the time being, 
innocuous, yet, as it is liable to be reabsorbed into the circu- 
lation, it may again prove active. Hence, in the treatment of 
a case of poisoning, the importance of completely eliminat- 
ing the noxious agent from the system. 

While we have no positive proof that all poisons are 
deposited in the organs, we know that this is true of the 
mineral, and of many of the vegetable poisons. The gaseous 
poisons appear to be eliminated by the lungs immediately, 
without this deposition. This was proven by Bernard, who 
injected into the jugular vein of a dog a cubic inch of water 



374 TOXICOLOGY. 

saturated with sulphuretted hydrogen. A piece of paper, 
wetted with solution of lead acetate, was held to the dog's 
mouth. It blackened in from three to five seconds, show- 
ing that the gas had been eliminated from the lungs. This 
elimination was completed in a few seconds. 

The time required for an absorbed poison to be removed 
from the circulation, either by elimination or by deposition 
in the organs or tissues, varies for different substances, and 
also probably, for different conditions of the system. Cer- 
tain medicinal substances are known to appear in the urine 
a few minutes after being swallowed — e. g., potassium iodid 
and turpentine. In relation to mineral poisons, there is 
reason to believe that they are rapidly separated from the 
blood. Experiments have shown that arsenic may be dif- 
fused throughout the body of an animal in an hour and a 
half after being swallowed. It has also been found in 
the urine of a horse within one hour after administration. 
Taylor found arsenic in the human liver four hours after 
being swallowed. Doubtless it reaches this organ much 
sooner than this, although no opportunity has as yet been 
afforded of proving the fact, since death rarely occurs 
earlier than the above period. Taylor believes that the 
liver acquires its maximum of saturation by arsenic in fifteen 
hours after the ingestion of the poison. He gives a table 
of the estimated average amount of this poison that will be 
found in this organ at different periods: In five to seven 
hours after taking, the quantity is 0.8 grain ; in nine hours, 
1.2 grains; in fifteen hours, 2.0 grains; in seventeen to 
twenty hours, 1.3 grains; in fourteen days, 0.17 grain. It 
is generally admitted that arsenic is entirely eliminated from 
the human system in about fifteen days, but cases have 
been reported where the poison was detected in the urine 



DISPOSITION OF THE POISONS. 375 

as late as the twenty-fifth day. As a rule, the analyst need 
hardly expect to find any traces of arsenic in the body of a 
person who has survived fifteen days after swallowing it. 

Other mineral poisons require a longer time for their 
elimination from the human body. According to Orfila, 
arsenic and corrosive sublimate require thirty days; anti- 
mony, four months ; silver, five months ; lead and copper, 
over eight months. 

This doctrine of the elimination of poisons must be held 
with some reserve. The question may at times assume 
very serious importance. Suppose a case of alleged arsen- 
ical poisoning, in which the deceased had survived two or 
three days, but in which the toxicologic examination failed 
to reveal any traces of the poison in the liver or other 
viscera. Here, the defense might very plausibly urge that 
the death was not caused by the poison, as alleged, inas- 
much as it could not be found in the viscera, where it ought 
to be discovered (according to authorities), if life was not 
protracted beyond fifteen days. There must be exceptions 
to the above rule, as in a case in which tliere had been ex- 
cessive vomiting and purging from the first, and the dose 
of the poison comparatively moderate. Taylor mentions a 
case of this nature, in which arsenic had caused death in 
twenty-six hours ; there had been much vomiting and purg- 
ing, and, on examination, the poison had nearly disappeared 
from those viscera in which it is usually found. In such a 
case, if the other evidences of poisoning were present, the 
negative chemical testimony is of less moment. On the 
other hand, a case may present itself (as it has to the author) 
in which a person who has been taking small doses of 
arsenic, medicinally, for a length of time, dies suddenly, 
with gastro-enteric symptoms and under suspicious circum- 



3/6 TOXICOLOGY. 

stances. Here, an examination of the liver may discover 
traces of arsenic, and this may be regarded by the prosecu- 
tion as proof of criminal administration, especially if it could 
be shown that the deceased had not taken the medicine for 
at least fifteen (thirty) days before death. In such a case, 
in the absence of all the other factors of evidence, the find- 
ing of traces of arsenic in the liver, within the period of 
time above mentioned, would not establish it as the cause 
of death. 

The Mode of Death by poisons has been a subject of 
much discussion. It must be admitted that we are not in 
possession of the full knowledge of this subject. We know 
that the various poisons circulate through the blood, and 
thus come in contact with some one of the great centers of 
life — the heart, the lungs, and the brain and spinal cord — 
and then and there produce their specific effects; one, on 
the brain, causing narcotism; another, on the heart, pro- 
ducing asthenia; a third, acting on the spinal' cord, causing 
tetanus, etc. ; but why they possess this elective affinity for 
these different organs we are unable to explain. Neither 
do we understand why different poisons exhibit a similar 
election in their modes of elimination from the system, e. g., 
potassium iodid passing out, by preference, through the 
urine; mercury, by the saliva; arsenic, by the glands of 
the stomach, etc. 

One mode in which death occurs by poisoning is prob- 
ably by shock on the general nervous system, as seen in 
the case of the powerful corrosives — their violent local ac- 
tion causing a general depression of the system very similar 
to that occasioned by a severe superficial burn or other 
severe injury. Most probably there is some histological or 



THE MODE OF DEATH. 3/7 

pathological change produced by the poison in the organ 
or tissue. 

The fact that poisons must enter the circulation before 
they can become effective naturally suggests the idea of 
some chemical or other change produced on the blood, and 
possibly on the poison itself. This, however, cannot be 
proved. As regards any physical alterations of the blood 
corpuscles, microscopic examination has failed as yet to 
discover anything that can be regarded as conclusive, al- 
though it has demonstrated alteration in their size, shape, 
and color, in the case of certain poisons. 

Modifying Circumstances connected with Poisons. — 

Some of these relate to the poison itself, and others are 
connected with the system. Among the former, the dose 
and mode of administration require notice. As a rule, the 
larger the dose, the more speedy the action. An exception 
to this is seen in the case of some irritants, such as arsenic, 
where a large dose may be rejected by vomiting, and might 
thus prove innocuous, while a smaller one would be re- 
tained. The effect of some poisons is much modified by 
the dose; thus, a large dose of oxalic acid kills almost 
immediately by shock, while a smaller one will act upon 
the heart and nervous centers, and prove fatal more slowly. 
The effect of combinations of poisons is sometimes to 
increase, sometimes to diminish, their activity, and again, 
to antagonize or neutralize their action. According to 
Christison, the effects of arsenic are decidedly modified by 
alcoholic intoxication, which seems in some way to arrest, 
or suspend its action. This is also probably true of other 
irritant poisons. The same authority mentions a case where 
a very large dose of corrosive sublimate and laudanum was 
33 



378 TOXICOLOGY. 

taken, and there was a remarkable postponement of all the 
usual symptoms. 

Antagonism of Poisons. — That an antagonism exists 
between certain poisons — the one neutralizing the effects of 
the other in the animal system — has been satisfactorily 
demonstrated. Experiments on frogs go to prove that this 
antagonism is of a twofold character — ^physiological and 
toxic. For example, calcium salts given in toxic doses 
occasion complete ventricular contraction in the frog's heart, 
the animal dying with the heart in systole. On the other 
hand, potassium salts produce relaxation of the ventricle, 
and death occurs in diastole. But by a careful equipoise 
in the dose of these two salts the physiological effects of 
each can be mutually and completely controlled and neutral- 
ized by the other, so that the normal action of the heart is 
restored, and the animal survives. A similar antagonism 
has been found to exist between veratrin and potassium salts 
— the alkaloid here acting precisely like a calicum salt in 
neutralizing the effects of the potassium salt. 

Hence we may regard the action of antidotes in cases of 
poisoning, as being of a twofold character — physiological 
and chemical. 

This question of antagonism acquires much greater in- 
terest and importance when we come to consider its bearing 
in certain cases of criminal poisoning, in which, in the ab- 
sence of the usual chemical and other recognized proofs of 
the alleged poison, the attempt is made to show that by a 
combination of poisons their action upon the human sys- 
tem will become so modified as to conceal the symptoms, 
and prevent their discovery after death by the usual chem- 
ical tests. It then assumes a considerable importance. This 



ANTAGONISM OF POISONS. 379 

doctrine was — for the first time, apparently, in this country 
— urged with some plausibihty, at the celebrated trial of Dr. 
Paul Schoeppe, at Carlisle, Pa., in 1869. After the failure 
by the prosecution to establish the allegation of poisoning 
by hydrogen cyanid (inasmuch as the single symptoms were 
rather those of apoplexy), it set up the claim that the death 
was produced by a mixture of hydrogen cyanid and morphin, 
and ascribed the absence of all the usual symptoms of the 
former, and the failure to detect either it (except by the 
merest trace, which was shown might result from the faulty 
method of the analysis) or the morphin, to the alleged 
antagonism of the two substances, although there was not 
the slightest evidence of the administration of either. In 
the year 1870 Dr. Reese made a number of experiments upon 
dogs, with a view of determining this question. A few of 
the results w^U be briefly detailed here : — 

1. Morphin and Hydrogen Cyanid. — If both poisons are 
given in full lethal doses, the symptoms of both toxic agents 
are exhibited. The morphin never counteracts the fatal 
effects of the other body, if the latter be taken in full poison- 
ous doses. 

2. Morphin and A tropin. — A mutually antagonizing in- 
fluence of these two alkaloids is not distinctly manifest in 
dogs. 

3. Strychnin and Hydrogen Cyanid. — These powerful 
poisons evince no real antagonism. When both were taken 
in full doses, the usual symptoms of each were exhibited 
alternately — convulsions and tetanic spasms. 

4. Strychnin and Morphin. — These alkaloids show no 
disposition to antagonism when given in full doses. The 
narcotism of the morphin (taken first) was speedily followed 
by the tetanus of the strychnin (taken afterward). 



380 TOXICOLOGY. 

5. Atropin and Eserin-. — The investigations of Dr. Frazer 
with these substances on dogs demonstrate a real antagon- 
ism, which was confirmed by Dr. Reese's experiments. 

6. Atropin and Strychnin. — There would seem to be a 
true antagonism between these two alkaloids, sufficient to 
justify a resort to the use of atropin in a case of strychnin- 
poisoning. 

There also appears good reason for admitting the antag- 
onism between Aconite and Digitalis — sufficiently so to war- 
rant a trial of digitalis in a case of poisoning by aconite. 

The conditions of the system that modify the action of 
poisons are habit, idiosyncrasy, and disease. Habit usually 
diminishes the power of poisons, as shown especially in 
the case of the narcotics, opium and alcohol. It is also 
alleged to be true in the case of arsenic, as seen in the 
arsenic-eaters of Styria and other mountainous countries. 

The effect of disease in modifying the action of poisons 
is witnessed in the tolerance by the system of opium in 
tetanus and mania-a-potu, and of its increased susceptibility 
to this drug in apoplexy and inflammation of the brain. In 
paralysis, the susceptibility to the action of strychnin is 
diminished. 

The influence of sleep is usually to diminish or retard 
the action of poisons. This is true of arsenic and the irri- 
tants generally. The narcotism produced by opium seems 
to produce a similar effect, and also to mask the symptoms. 

A knowledge of the Evidences of poisoning constitutes 
an important point to the toxicologist. These evidences 
comprise (i) those derived from the Symptoms; (2) those 
obtained from the Post-mortem appearances; (3) those 
afforded by Chemical analysis; (4) those derived from 
Experiments on animals; (5) the Moral or Circumstantial 
evidences. 



ANTAGONISM OF POISONS. 38 1 

I. Evidences afforded by Symptoms. — These constitute 
a very important factor in the diagnosis of poisoning, but, 
alone, they can never be sufftcient to establish the fact al- 
though they often furnish a very strong presumption. There 
are no characteristic symptoms of any poison ; if this were 
the case there v^ould be no need of ever making a chemical 
examination, since the symptoms alone would be sufficient 
to decide the case. To this there may be an exception in 
poisoning by the strong mineral acids and alkalies, the local 
action of which is so apparent. 

The first point to notice is the sudden occurrence of 
violent symptoms in a perfectly healthy person, soon after 
taking food or drink. Most poisons produce their effects 
very soon after their administration — some of them almost 
immediately. But if given in very small quantities, and at 
intervals, as in slow poisoning, the symptoms may come on 
gradually, and be readily mistaken for disease. The physi- 
cian should be extremely cautious about mentioning suspi- 
cions of poisoning in a case of this character before he has 
thoroughly investigated the case. 

The suspicion is strengthened if several persons, after 
partaking of the same food, are suddenly seized with the 
same severe symptoms. But even here it might happen 
that some disease, like cholera, may have simultaneously 
attacked several persons after partaking of a meal. Taylor 
mentions an instance of this character, occurring in London, 
where three out of four members of a family, under suspi- 
cious circumstances, were suddenly seized with violent symp- 
toms that were strongly indicative of irritant poisoning, but 
which proved to be malignant cholera, which was prevailing 
at that time. 

A third feature connected with the symptoms is their 



382 TOXICOLOGY. 

rapid course toward a fatal termination. This, however, is 
not of much practical value, since the most active poisons 
do not always prove fatal immediately, while, on the other 
hand, many diseases run their course very rapidly. 

From what has just been said about symptoms it will be 
readily understood that the practical difficulty consists in 
distinguishing between these and the symptoms of disease. 
We shall, therefore, briefly consider those diseases whose 
symptoms most resemble the symptoms accompanying 
poisoning. The disorders which most simulate irritant 
poisons are cholera morbus, malignant cholera, gastro- 
enteritis, peritonitis, ulceration of the stomach, ileus, and 
hernia. Those which most resemble narcotic poisoning 
are apoplexy, epilepsy, inflammation of the brain, tetanus 
and certain cardiac diseases. 

Cholera morbus strongly resembles arsenic poisoning, and 
is frequently mistaken for it. Two cases of this character 
were reported, in which death occurred in about eight 
hours, both of which were mistaken for cholera morbus 
by the attending physician, and were so certified before the 
Board of Health; but both of which, however, yielded, by 
analysis, the most positive evidence of arsenical poisoning. 

Malignant cholera most resembles the action of tartar 
emetic in its symptoms, such as the excessive nausea and 
vomiting, the rice-water dejections, the cramps, the ex- 
treme weakness, etc. G astro- enteritis, peritonitis, ulcera- 
tion of the stomach, ileus and hernia all present symptoms 
which strongly resemble many of those witnessed from 
irritant poisons. 

Many of the features of apoplexy bear a striking resem- 
blance to the symptoms of opium poisoning ; whilst epilepsy 
in some of its symptoms resembles poisoning from hydro- 



EVIDENCES FROM POST-MORTEM EXAMINATION 383 

gen cyanid ; and the effects of strychnin bear a strong like- 
ness to these of tetanus. 

A knowledge of the above facts should put the practi- 
tioner upon his guard against too hastily deciding on a case 
of poisoning from the symptoms alone; and, on the other 
hand, he should not be misled in attributing to a supposed 
disease what is really the result of a poison. 

II. Evidences obtained from Post-mortem Examina- 
tion. — The rules governing an autopsy in a case of poison- 
ing are the same as those which regulate other post-mortem 
examinations. One important rule should always be ob- 
served, namely, that the examination should be thorough 
and exhaustive, so as to overlook no lesion and no cause 
of either accidental or natural death. The rules already 
given for conducting a post-mortem investigation need not 
be repeated here. 

The importance of receiving the stomach and other 
viscera into a perfectly clean jar may be inferred from the 
fact that the showing that this vessel was not clean, at the 
trial, would be sufficient to destroy all the chemical testi- 
mony. This is well illustrated by a case in the experience 
of Robert Bridges. The viscera had been carelessly placed 
in a tin can that had contained zinc paint. The analyst 
discovered zinc in the viscera, for which he was at a loss to 
account until the above fact was ascertained. 

In the examination of the stomach it is recommended to 
open this organ along the lesser curvature, and, after care- 
fully collecting and measuring the contents, to spread it 
out upon a clean pane of glass or large flat dish, with the 
mucous surface outward ; it should then be carefully in- 
spected, with the aid of a magnifier, and any abnormal 



384 TOXICOLOGY. 

appearance noted, together with any foreign substance, such 
as crystals of arsenic, fragments of phosphorus, suspicious 
powders, pieces of vegetable matter, etc. These should 
afterward be examined with the microscope. 

The evidences furnished by the post-mortem, like those 
derived from the symptoms, can never be absolutely con- 
clusive, but only strongly suggestive ; for many diseases 
exhibit precisely the same post-mortem lesions. Some- 
times the external inspection of the body may throw some 
light on the case, as when certain stains of the mineral 
acids are discovered about the mouth, cheeks, tongue, and 
faces, and also on the dress of the person. Occasionally 
the odor of hydrogen cyanid, opium, alcohol, nicotin, or 
phosphorus may be perceived on the corpse. On opening 
the body, the odor of such substances, if present, is usually 
more decided; and in phosphorus-poisoning the white 
fumes, which are luminous in the dark, as well as the 
garlic-like odor, are often very perceptible. Again, the 
remnants of certain poisons may be at times discovered in 
the stomach and bowels, such as cantharides, Scheele's 
green, nux vomica, arsenous oxid, and orpiment; also 
vegetable leaves and fibers, which latter may be recognized 
by their structure. The aid of the microscope may here 
be required. 

As regards the true pathological lesions resulting from 
poisoning, it may be remarked that, as a rule, the irritant 
poisons leave behind them decided marks of congestion and 
inflammation of the mucous membrane of the stomach and 
bowels, together, at times, with ulceration, perforation, and 
gangrene; while the neurotics leave their impress upon the 
brain and spinal cord, in the form of congestion, inflamma- 
tion and effusion in these organs, and sometimes congestion 



EVIDENCES FROM POST-MORTEM EXAMINATION 385 

of the lungs. The negative evidence, in the absence of all 
marks of irritation of the stomach and bowels, against irri- 
tant poisoning, although strong, is not absolute, because, in 
exceptional cases, death from these powerful irritants may 
occur without leaving behind any pathological lesion. 

Among the most common of the post-mortem signs pro- 
duced by irritant poisons is redness ; this, however, is a 
constant symptom attendant on many disorders ; and it 
occurs simply as a post-mortem change. A similar conges- 
tion is also witnessed in some cases of death by suffocation, 
strangling, hanging, and drowning. The examiner should 
hence beware of attaching too much importance to this sign 
exclusively. Ulceration is occasionally the result of irri- 
tant poisoning. It is, however, much more frequently the 
sequence of disease ; and, as this latter is apt to be insidi- 
ous and generally unsuspected until a sudden fatal termina- 
tion, it might readily be mistaken for a case of poisoning. 
Softening of the mucous lining of the stomach and bowels 
may result from both poisoning and disease ; it cannot, 
therefore, be accepted as a proof of the former. Perfora- 
tion may occur from the action of a corrosive, as the min- 
eral acids and alkalies, and also from disease ; but in the 
latter case the aperture is small, while in the former it is 
large and ragged, and its edges are soft and friable ; more- 
over, the poison escapes into the abdomen, and can there 
readily be detected. 

All s 'stances taken in doses sufficient to cause severe 
symptoms probably produce structural and chemical changes 
in the visceral tissues, but as yet the data are very incom- 
plete. Some well-established conditions will be noted in 
connection with particular poisons. The following table of 
effects of different poisons on the condition of the blood is 
taken from DaCosta's '' Clinical Hematology " : 
34 



386 


tOXICOLOGV. 


Substance. 


Effects. 


Alcohol, 


Anemia, often leukocytosis. 


Amyl nitrite, 


Methemoglobinemia. 


Acetanilid, 


Methemoglobinemia. 


Ammonium hydroxid, 


Leukocytosis. 


Antipyrin, 


Methemoglobinemia. 


Bromin, 


Methemoglobinemia. 


Chloral, 


Leukocytosis. 


Chromic acid. 


Methemoglobinemia. 


Ether, 


Oligochromemia. 


Guaiacol, 


Hemocytolysis, leukocytosis. 


Hydrogen cyanid, 


Methemoglobinemia. 


Illuminating" gas, 


Methemoglobinemia, polycy- 




themia. 


lodin. 


Leukocytosis, methemoglobi- 




nemia. 


Lead, 


Anemia, granular absophilia. 




often leukocystosis. 


Nitrobenzene, 


Methemoglobinemia, megalo- 




blastic anemia. 


Nitroglycerin, 


Methemoglobinemia. 


Phenacetin, 


Methemoglobinemia. 


Phosphorus, 


Polycythemia, occasionally 




leukocytosis. 


Potassium chlorate, 


Methemoglobinemia, anemia, 




leukocytosis. 


Sodium nitrite, 


Methemoglobinemia. 


Poisonous mushrooms, 


Hemoglobinemia. 



III. Evidences from Chemical Analysis. — The actual 
discovery of the poison by means of chemical analysis is 
usually regarded as the most satisfactory and positive evi- 



EVIDENCE FROM CHEMICAL ANALYSIS. 387 

dence of poisoning; and it is a prevalent notion that the 
case cannot be made out, without the production of the 
poison, as the corpus delicti. This is, however, an error. 
The law requires the satisfactory proof of death by poison- 
ing. The question is, Can satisfactory proof be afforded 
without the chemical detection of the poison? The reply 
to this inquiry is that it undoubtedly can, in certain cases. 
Many convictions have occurred in trials for poisoning, 
without this particular line of proof. If it were always 
deemed absolutely essential, doubtless many criminals 
would escape. It is well understood that for certain poisons 
there is no known characteristic test ; besides, circumstances 
may interfere to prevent a proper examination. If, how- 
ever, the other branches of evidence fail, and if, at the same 
time, the analytic proofs are unsatisfactory, then the case 
must be abandoned. 

On the other hand, supposing the analysis reveals the 
presence of poison in the stomach, this does not necessarily 
prove that the death resulted from poisoning. Indeed, in the 
absence of the usual symptoms, the pathological lesions, and 
other proofs, it might plausibly justify the suspicion that the 
poison had been secretly introduced into the body after death, 
for sinister purposes, or without evil intention, as in the case 
of so-called embalming with certain poisonous mineral sub- 
stances. 

The detection of the absorbed poison in the organs, as 
the liver, spleen, kidney, etc., is justly regarded as a more 
satisfactory proof of poisoning than the" mere discovery of it 
in the stomach. It should not be forgotten that if a poison 
in a liquid state be introduced into the stomach or rectum 
of a dead body, by means of a tube, in a short time the 
liquid will diffuse through the walls of the viscus, will come 



388 TOXICOLOGY. 

in contact with the adjacent organs — the liver, lungs, pan- 
creas, kidney, spleen, etc. — and will penetrate so as to con- 
taminate them more or less. The same result would occur 
if the body had been embalmed by the injection into the 
blood-vessels of some poisonous material, such as arsenic 
or corrosive sublimate. Now if, after several weeks' or 
months' interment, a suspicion be aroused that the death 
had been caused by poison, and the body then be opened, 
very decided evidences will be afforded by the different 
organs of what might very naturally be mistaken for ab- 
sorbed poison. 

The author is familiar with a case of post-mortem imbi- 
bition, the particulars of which were communicated to him ; 
and in order to establish the possibility of its occurrence, 
together with the circumstances most favorable for its pro- 
duction, he had a series of experiments made, under his 
supervision, by Dr. Geo. McCracken, of the University of 
Pennsylvania, on the bodies of dogs and cats, with solutions 
of arsenous oxid, corrosive sublimate, and tartar emetic, 
confining his experiments, for the time, to mineral poisons. 
These solutions were severally injected into the stomachs 
of the animals, and their bodies were buried for periods, 
respectively, of three, five, six, and seven weeks, when 
they were disinterred, opened, and the different viscera 
subjected to careful analysis, with the following results: 
After three weeks' burial, in the case of all the poisonous 
solutions, the characteristic colored spots of the respective 
sulphids were seen on the spleen, under surface of the 
liver, and that portion of the peritoneum posterior to the 
stomach : yellow in the case of arsenic, red in the case 
of antimony, and black in the case of mercury. Each of 
the metals was likewise discovered by analysis in the liver, 



EVIDENCE FROM CHEMICAL ANALYSIS. 3CS9 

spleen, and left kidney, the greatest amount being found in 
the spleen ; next, in the portion of the liver joining the 
stomach ; then in the left kidney ; and next in the portion 
of liver farthest from the stomach, and none in the right 
kidney. After six and seven weeks' interment, the colored 
sulphid deposits v^ere much more decided, being noticed on 
the upper, as well as the lower, surface of the liver, to- 
gether with the spleen, intestines, omentum, and both kid- 
neys, and, in the case of arsenic, even extending as low 
as the fundus of the bladder. The poisons were detected 
in all the above-mentioned organs. 

The inference from the above facts would naturally lead 
to the necessity of considering the question of the post- 
mortem introduction of the poison, in every toxicologic 
investigation. It is evident that it would often not be a very 
difficult matter secretly to introduce a poisonous liquid into 
the stomach of a dead person, and, after the lapse of a few 
weeks or months, to circulate the rumor of the death having 
been produced by poison. This would probably lead to 
the disinterment of the body, and the analytic examination 
would reveal the existence of the poison, not only in the 
stomach, but also in the liver and other viscera. The con- 
clusion then would naturally be that the individual had 
died from poison, because it had been discovered in the 
organs. The case may occur (as has actually occurred) in 
which there was a strong suspicion of death from arsenical 
poison, but in which the body was embalmed immediately 
after death by the injection of an arsenic solution into the 
abdomen, with the intention, doubtless, of confusing the 
results of analysis. 

Now, the all-important question here is : Is it possible to 
discriminate, by a post-mortem examination of the liver and 



390 TOXICOLOGY. 

Other organs of the body, between a genuine case of poison- 
ing and one in which these same organs had become affected 
by post-mortem imbibition? Certainly not by merely ana- 
lytic tests, since these would afford similar results in both 
cases. Until quite recently it seemed that a poison injected 
into the stomach or bowels of a dead body, or in the pro- 
cess of embalming, could not penetrate through the bony 
cavities of the cranium and spinal canal, by osmosis, as we 
know to be the case with the different organs of the abdo- 
men and chest. Nevertheless, certain experiments in this 
line, performed by Dr. G. B. Miller and Mr. F. S. Sutton, 
of Philadelphia, do seem to prove that a solution of arsen- 
ous oxid (and, infer entially, other poisons), injected into the 
stomach of a dead animal, can, after a sufficient lapse of 
time, be discovered in the brain and spinal marrow, and 
even in the bones of the cranium, by the usual analytic 
reagents. But how this diffusion can be accomplished 
through the bony walls of these cavities is difficult to under- 
stand. 

The results of some later experiments of Dr. Miller in- 
dicate that strychnin (and presumably the other alkaloids), 
when injected into the stomach of a dead rabbit, will pene- 
trate by imbibition into the liver, spinal cord, and bladder; 
the poison having been detected in these localities, though 
not in the brain. 

Experiments made by Vaughan and Dawson, and also 
by Witthaus, on human cadavers, have shown that compara- 
tively rapid diffusion of poison may occur when it is intro- 
duced after death. In one experiment (Witthaus) the 
brain contained .00828 gram of arsenous oxid five days 
after the injection of 16.56 grams in solution into the 
stomach. Even the long-continued external application of 



POST-MORTEM IMBIBITION OF POISONS. 39 1 

cloths containing arsenical solutions has resulted in ab- 
sorption into the abdominal viscera, as in a case reported 
by Mason. 

Dr. Charles Harrington has kindly furnished the follow- 
ing details of an interesting case of post-mortem imbibition. 
A man died of what was certified to be influenza. There was 
no reason to suppose foul play, but some of the relatives, 
dissatisfied with the terms of the will of the deceased, al- 
leged poisoning, and the authorities were obliged to make 
an examination. The body had been embalmed with a 
solution containing much arsenic and then placed in a re- 
ceiving vault because the weather was too cold to permit 
the digging of the grave. When the body was prepared 
for examination it was found to be frozen ; the post-mortem 
was proceeded with as soon as it was sufficiently thawed. 

The stomach, intestines, liver, kidneys and spleen ap- 
peared to be absolutely normal. There was no sign of 
irritation or fatty degeneration. The spinal canal was 
opened and the cord removed, taking great pains not to 
allow it to come in contact with any of the other parts, and 
also not to transfer the embalming fluid to it with instru- 
ment or fingers. Analysis of the cord gave very strong 
evidence of the presence of arsenic. 

These observations tend to deprive us of important 
means of discrimination. Probably, the next best criterion 
in such an uncertainty is the fact alluded to by Orfila that, 
in a case of true post-mortem imbibition, the poison would 
be found on the exterior rather than on the interior of the 
organs ; while in a case of poisoning, the absorbed poison 
would probably be deposited uniformly in the interior of the 
organs. 

Again, the discovery of the poison in the solid state in 



392 TOXICOLOGY. 

the stomach might be regarded as strong evidence of ante- 
mortem administration ; but the finding of a liquid poison 
in that organ, although strongly suggestive, is not positive 
proof of the same, since, as we have seen, it is possible to 
inject such a liquid into this cavity after death. 

Still another aid in this investigation is afforded by test- 
ing the urine. The discovery of the suspected poison in 
this secretion might be regarded as conclusive evidence of 
ante-mortem administration. But even this is open to the 
possible objection that the bladder, in common with the 
other abdominal viscera, might be contaminated by imbibi- 
tion of the injected poison, which might thus possibly affect 
the contained urine. Probably the most satisfactory and 
scientific diagnostic mark would be the microscopic proof 
of a histological and pathological change wrought in the 
tissue or organ impregnated with the poison. This could 
only occur by absorption of the poison during life ; such 
changes are not induced by poisons introduced into the 
dead body. It is very certain that this important subject 
requires further attention on the part of experts. 

Analysis sometimes fails entirely to discover the poison 
after death, and for this failure several good reasons can be 
assigned : ( i ) It may all have disappeared before death by 
vomiting and purging, and by elimination through the 
secretions. Arsenous oxid, however, is very apt to adhere 
to the mucous lining of the stomach, in spite of long and 
violent vomiting. (2) It may be undiscoverable by tests at 
present available. (3) Loss by absorption and elimination 
may occur. This is apt to be the case when the dose of 
the poison was only just sufficient to cause death, and 
death not very rapid. (4) The decomposition of the poison 
in the blood or during its elimination. This is much more 



FAILURE OF CHEMICAL ANALYSIS. 393 

apt to occur with organic than with inorganic substances. 
(5) Its possible decomposition in the dead body. This 
does not occur with the mineral poisons ; although the 
chemical composition of these may undergo change after 
death, as, e. g., arsenous oxid into the yellow sulphid, yet 
the element remains. (6) The presence of one or more 
ptomaines may seriously complicate the detection of some 
poisons. 

In performing a toxicologic analysis, certain rules should 
be observed. The examiner should, if possible, inform 
himself of the character of the symptoms, and, if the case 
was fatal, of the post-mortem appearances, as these will 
usually indicate to what particular class of poisons he should 
direct his researches. In searching for the more complex 
organic poisons, it is a good plan to reduce the liquid, by 
evaporation at a gentle heat, to a very small bulk, since a 
minute quantity of a poison diffused through a large amount 
of water may fail to respond to the proper tests. It is best, 
also, to operate on one half of the material, reserving the 
other portion in case of accident or for further experiments. 
The suspected substance ought to respond to all the recog- 
nized tests, the characteristic ones being first applied ; and 
in metallic poisoning it is often required to produce the 
element as evidence. This can always be accomplished 
without much difficulty in the case of arsenic, mercury, anti- 
mony, copper, lead ; but it should also be remembered that 
the results are modified by the quantity of the reagent em- 
ployed. Reliance should not be placed on the mere color of 
precipitates, as this is often fallacious, from being disguised 
by admixture with foreign matters, or uncertain, from its 
resemblance to other substances. As instances may be cited 
the impure arsenic and antimony sulphids, the precipitates 



394 TOXICOLOGY. 

in the liquid tests for arsenic, and the resemblance between 
the action of ferric salts upon the saliva and upon hydrogen 
cyanid. Finally, the analyst should be careful to test the 
purity of all his reagents, remembering that many of the 
so-called pure reagents often contain impurities, which may 
seriously damage his examination. As an example of the 
liability of reagents to contain impurities, the case recently 
reported by Vaughan may be cited. Fifty cubic centimeters 
of a sample of ether, sold as pure and intended for use in 
analytic work, was found to contain an organic body of 
such poisonous character that it killed a guinea-pig in ten 
minutes. 

IV. Evidences from Experiments on Living Animals. 

— When the poison cannot be identified by the symptoms, 
post-mortem lesions, and chemic tests, the suspected ma- 
terial may be introduced into a living animal, and its efifects 
noted. In the case of strychnin, the frog would be appro- 
priate as a corroborative test. Birds are not so well adapted 
for experiment. The character of the information thus de- 
rived is confined to the mere fact of poisoning, together with 
some of its physiologic and pathologic actions. By this 
means the presence of digitalin was identified in a celebrated 
French case, and aconitin in the case of Dr. Lamson, in 
England. 

The material to be employed in such cases is usually the 
matters vomited, or that found in the stomach and bowels 
of the deceased ; but the examiner should avoid a too hasty 
conclusion, inasmuch as disease might cause the secretions 
of the alimentary canal to become infected, and thus to act 
upon the animal poisonously, although no poison had really 
been taken by the deceased ; and on the other hand, although 



EVIDENCES FROM CIRCUMSTANCES. 395 

poison may originally have been present in the stomach, it 
might have all been expelled by vomiting, or undergone 
decomposition, so that the contents of the stomach would 
no longer produce a poisonous impression on the animal. 
When the quantity of the material is small, as in the case 
of an ultimate vegetable extract, it is advisable to introduce 
it into a very small animal, as the mouse, hypodermically. 
Another fact to be noticed in this connection is that a 
poison may be introduced into the human system through 
the body of an animal, without the latter being affected by 
it. A case is recorded where a family exhibited all the 
evidences of belladonna-poisoning after partaking of a rab- 
bit pie; the defense, which was successfully set up, was 
that the animal had previously eaten of the belladonna 
plant, by which its flesh had become poisonous. It is well 
known that the cow and goat will feed upon stramonium 
with impunity, and that their milk will act poisonously upon 
those who partake of it. 

V. Evidences Derived from Circumstances. — The med- 
ical expert is not directly concerned with this sort of testi- 
mony, and it is best for this feature of the question to be 
left to the legal authorities. In poison cases, however, the 
medical and other evidence is so closely connected that the 
expert may be consulted in regard to the latter. These 
" circumstances " are the following : ( i ) Any suspicious 
conduct of the accused before the event. (2) Proof of the 
purchase and possession of poison by the accused. Of 
course, this may be satisfactorily accounted for ; though often 
remarkable reasons are assigned by the accused, as in a 
New Jersey case, where a woman was tried and convicted 
for attempting to poison her son with successive small doses 



39^ TOXICOLOGY. 

of croton oil ; the alleged reason for its purchase and posses- 
sion being that it was for the cure of her corns. (3) The 
proof of administration in the food or drink of the deceased. 
(4) A sufficiently strong motive for the act. (5) Suspicious 
conduct of the accused during the illness and after the death 
of the deceased — such as preventing his obtaining medical 
advice ; assuming the exclusive care of the person, as to 
the giving of his food or administering the medicines ; care- 
fully removing and disposing of all vomited matters, to- 
gether with the excreta; and expressing the opinion of the 
probability of a speedy and fatal termination of the case ; 
and, after the death, opposing an autopsy, hastening the 
burial, and giving a false account of the ijlness. 

Certain questions will naturally present themselves in 
every case of poisoning that comes up for trial : ( i ) Is the 
death or sickness to he ascribed to poison? This question is 
fundamental, as it compels the expert to exhibit his proofs 
of the poisoning. (2) What, is the nature of the alleged 
poisoning? It is rarely in the power of the toxicologist to 
exhibit the identical poison that caused the death, as the 
corpus delicti. In most cases, all that is possible to do is to 
demonstrate all the known chemic and (occasionally) phy- 
siologic tests. In the case of the mineral poisons, it is 
deemed sufficient to exhibit the element and the results of 
the recognized chemical reactions. In some cases of min- 
eral poisons, however, it is possible to extract the identical 
substance that was administered — such as arsenous oxid, 
corrosive sublimate, tartar emetic, etc. — by the process of 
dialysis. (3) Was the substance administered capable of 
causing death? If it can be shown that the substance, 
although criminally administered, was not poisonous, al- 
though supposed to be, it would not be possible to establish 



EVIDENCES FROM CIRCUMSTANCES. 397 

a case of poisoning; neither, if the substance were poison- 
ous only in large doses, as oxalic acid, and a very small 
quantity, only a few grains, had been given. (4) Was the 
poison taken in sufficient quantity to produce death? The 
discovery of a large amount of poison in the body is a 
pretty sure evidence of the cause of death ; but the finding 
of only a minute quantity, or its total absence from the 
body, is not positive proof that death was not caused by 
poison. (5) When was the poison taken? This question 
can generally be answered by referring to the time of the 
first appearance of the symptoms, together with their dura- 
tion ; but it is affected by various conditions. (6) May the 
poison harue entirely disappeared from the body without leav- 
ing any trace? The answer must be affirmative if the per- 
son has survived long enough to allow of its complete 
elimination. (7) Might the poison found in the body be as- 
cribed to any other source than to poisoning? Not as a 
general rule, if it is found in considerable quantities, and in 
the absorbed state in the organs, although the possibility of 
post-mortem imbibition should not be forgotten. But if in 
minute quantity, it might have been introduced medicinally 
or accidentally. (8) Can poisoning be pretended? Undoubt- 
edly, just as various diseases are feigned for some special 
motive. The idea of being poisoned is a very common 
delusion of the insane. 

This summary is chiefly from Tardieu. 

Classification of Poisons. — Of the numerous classifi- 
cations of poisons which have been proposed at various 
times, one only requires notice here. This, which may be 
termed the physiologic, has reference to the effects of poi- 
sons upon the healthy system, and, as adopted in the pres- 



39B TOXICOLOGY. 

ent treatise, is founded upon the latter arrangement as 
being the most philosophic. It is based upon the one pro- 
posed by Taylor, with a few modifications which render it 
simple and convenient. 

Poisons are divisible into two Classes: I. Irritants; II. 
Neurotics. 

I. Irritants. — These include such poisons as produce an 
irritant action upon the mucous lining of the alimentary 
canal, the effects being nausea, vomiting, purging, pain in 
the abdomen, cramps in the stomach and other parts of the 
body; the matters vomited and purged being at times 
mixed with blood. The post-mortem lesions are more or 
less inflammation of the gastro-intestinal mucous mem- 
brane; sometimes ulceration, perforation, and gangrene. 

The irritants may be divided into the Corrosives and Irri- 
tants proper. The former produce local destruction of 
tissue, the eft'ects of which often overshadow the true in- 
ternal action. 

II. Neurotics. — These are so named on account of their 
specific action on the nervous centers. The symptoms are 
altogether distinct from those of the former class, being 
directed especially to the brain and spinal cord. These are 
drowsiness, giddiness, headache, delirium, stupor, coma, 
and sometimes convulsions and paralysis. They are natur- 
ally subdivided into three Orders : (i) Cerebral, (2) Spinal, 
(3) Cerebro-spinal. The first of these Orders comprises 
Narcotics and Anesthetics. The second Order includes those 
which act directly upon the spinal cord, such as strychnin; 
they are sometimes termed Tetanies. The third Order com- 
prises those which influence both the brain and spinal mar- 
row, producing delirium, coma, convulsions, and paralysis. 
These latter may be grouped under the three heads of 



MINERAL ACIDS SYMPTOMS. 399 

Deliriants, Depressants, and Asthenics. The above arrange- 
ment is to a great extent an arbitrary one, and must, of 
course, be somewhat imperfect, as the boundary Hne be- 
tween the different classes and orders of poisons cannot 
always be accurately drawn. 

CORROS IVE IRRITANT S. 

MINERAL ACIDS. 

The Mineral Acids — Sulphuric, Nitric, and Muriatic — 
possess certain common characters, and produce certain 
common effects upon the system, and may properly be con- 
sidered together. This action is largely local, although 
death is sometimes due to the shock upon the nerve-centers. 
They are seldom used for homicidal purposes, except in 
the case of young children ; they are occasionally em- 
ployed by suicides, but more frequently cause death by 
accident. 

Their symptoms are exhibited immediately on being 
swallowed ; these consist of a burning in the mouth and 
throat, with intense pain in the stomach, attended with con- 
stant vomiting of a brownish or blackish matter, often 
mixed with blood, together with mucus and shreds of 
detached mucous membrane. The ejected matters are in- 
tensely acid, and if they happen to fall upon a marble slab 
they produce effervescence ; they also change the color and 
destroy the texture of the cloth or other material on which 
they may fall. Swallowing is very painful, and sometimes 
impossible. Thirst is intense; the bowels are constipated 
and the urine diminished. The pulse is small and weak, 
and the skin cold and clammy. Respiration becomes diffi- 
cult, and the countenance expressive of great anxiety. There 



400 



TOXICOLOGY. 



may also be cough and difficulty of speaking. Death may 
occur from suffocation when the force of the acid is spent 
upon the glottis and upper portion of the windpipe. The 
mouth is excoriated and the lips are stained and shriveled. 
When the acid has been poured far back down the throat, 
in the case of infants, the mouth and lips may entirely escape 
injury, the corrosive action being confined to the glottis and 
adjacent parts. The mental faculties usually remain clear 
until near death. 

The result is generally fatal, although the period of 
death may vary from a few hours to weeks or months, death 
often taking place as a result of injury done by the poison 
(e. g., stricture of esophagus, destruction of mucous coat 
of stomach). 

Post-mortem Appearances. — Stains of a brownish or yel- 
lowish hue are apt to be found on the lips and cheeks ; also 
on portions of the dress of the deceased. The lining of the 
mouth and tongue is shriveled and eroded, stained yellowish 
in the case of nitric acid, and sometimes of a whitish color. 
At times the mucous membrane of the windpipe appears to 
have suffered most from the corrosive action of the poison, 
and cases are reported of sulphuric-acid poisoning in which 
all other parts of the body had entirely escaped. The lining 
membrane of the esophagus is usually softened, detached in 
long shreds, and deeply congested; the stomach contracted, 
often perforated, sometimes blackened, containing a dark 
grumous liquid; at other times it presents a yellowish ap- 
pearance. The intestines are likely to be inflamed, unless 
the death has been very rapid. If the contents of the 
stomach have escaped into the cavity of the abdomen, 
through perforation, the peritoneum will be found intensely 
inflamed, with more or less dark, effused blood. 



SULPHURIC ACID — TOXICOLOGIC EXAMINATION. 40 I 

Treatment. — No remedies are likely to prove efficient 
when an undiluted acid has been swallowed. The proper 
treatment consists in administering baking soda, chalk, or 
magnesia, stirred up in water, barley water, flaxseed tea, 
oil, etc. The stomach pump should not be employed, on 
account of the risk of perforating the softened esophagus. 

Sulphuric Acid. — This acid is commercially named Oil 
of Vitriol. In its concentrated state it is a heavy, oily liquid, 
of a light brownish color; sp. gr., 1.845; intensely sour. 

The highly diluted acid is colorless and non-corrosive ; 
paper which has been dipped into it and dried by gentle 
heat will be charred. 

Sulphuric acid is more frequently the cause of death than 
the other mineral acids. Homicidal deaths are occasionally 
met with among infants, and several cases are reported 
where it was introduced into the rectum and vagina. The 
fatal dose for an adult is about a fluid drachm ; for an infant, 
half this quantity ; but the danger depends more on the 
degree of concentration than upon the absolute quantity 
swallow^ed. Death usually occurs within twenty-four hours, 
and in cases where its action is spent upon the rima glottidis, 
producing suffocation, the fatal result may be almost im- 
mediate. According to Casper, the bodies of those poisoned 
by sulphuric acid resist putrefaction for a long period. 

There seems to be reason for believing that this acid 
is absorbed into the circulation and eliminated by the 
secretions. 

" Vitriol throwing " — that is, the throwing of strong sul- 
phuric acid on the person of another — occurs occasionally, 
the motive being generally revenge or jealousy. Much 
local injury is often produced. Copious effusion with water 
is the best treatment. 
35 



402 TOXICOLOGY. 

Analytic Methods. — The concentrated acid is recognized 
by its oily appearance ; it chars organic bodies ; it evolves 
considerable heat when mixed with an equal bulk of water. 
The diluted acid is easily detected by its producing, with 
barium chlorid, a white precipitate insoluble in nitric acid. 
To confirm this result, the precipitate (barium sulphate) 
should be dried and mixed with some reducing agent 
(charcoal, potassium ferrocyanid), and heated to redness; 
the barium sulphate is by this means converted into the 
sulphid, and when this is moistened with diluted hydro- 
chloric acid the smell of hydrogen sulphid is at once per- 
ceived, proving the presence of sulphur. 

Several other acids besides sulphuric give white precipi- 
tates with barium salts, but nitric or hydrochloric acids will 
dissolve these, while the sulphate remains unaffected. 

Any sulphate will produce the same precipitate with 
barium chlorid as the free acid. The two may easily be 
distinguished by heating a little of the liquid in a watch- 
glass over a steam-bath. Sulphuric acid does not dry up, 
while a solution of a sulphate will form crystals. The solu- 
tion contains both the free acid and some soluble sulphate; 
finely powdered barium carbonate should be added, first 
warming the liquid; this will precipitate the free sulphuric 
acid only ; hence the resulting barium sulphate will repre- 
sent all the free acid present. 

Another delicate test is veratrin. A small portion of this 
alkaloid is introduced into the diluted acid and carefully 
evaporated to dryness ; a beautiful crimson-purple color is 
developed. Moreover, as this test produces no effect upon 
a sulphate, it serves to distinguish the latter from the free 
acid. 

Toxicologic Examination. — The organic matters, if thick 



SULPHURIC ACID — TOXICOLOGIC EXAMINATION. 403 

and viscid, should be boiled with the addition of distilled 
water and the solution filtered, and a measured portion, 
acidified by hydrochloric acid, precipitated hot by barium 
chlorid, and the precipitate washed and dried. This precipi- 
tate may be reduced by heat- and potassium ferrocyanid, and 
further tested as mentioned above. 

It might happen that the solution contained a soluble 
sulphate along with some other acid — citric, acetic, etc. 
The mode of distinguishing this from a solution containing 
free sulphuric acid is as follows : a given volume of the 
solution is acidulated with acid, and precipitated with 
barium chlorid, and the precipitate washed, dried, and 
weighed. An equal volume of the original solution is 
evaporated to dryness, and heated in order to drive off any 
free sulphuric acid, and is then dissolved in pure water, 
filtered and precipitated as before, and the dried deposit 
weighed. If the weight of each of these precipitates is 
equal, there was no free sulphuric acid present ; but if the 
weight of the former precipitate exceeds that of the latter 
one, then the excess of weight will indicate exactly the 
amount of the free acid present in the original solution. 
The evaporation of sulphuric acid must be conducted under 
good ventilation, as a few drops of it will render a large 
room almost uninhabitable. 

Tardieu and Roussin recommend the following process 
(which is also adopted by Blyth) for determining free sul- 
phuric acid when associated with a sulphate. The object is 
to saturate the free acid with a base, the sulphate of which 
is soluble in alcohol : this base is quinin. To a measured 
portion of the suspected solution, quinin, recently precipi- 
tated and washed, is added in slight excess, and the whole 
evaporated on a water-bath. The semi-liquid extract which 



404 TOXICOLOGY. 

remains is exhausted with absolute alcohol; the alcoholic 
solution is evaporated, filtered, and evaporated anew, and 
the resulting extract dissolved out in a small quantity of 
boiling distilled water, and immediately filtered. If the 
amount of free sulphuric acid is at all considerable, the 
quinin sulphate crystallizes out on cooling; but if small, 
and in either case, the presence of the acid can be proven 
by the barium test. 

It may happen that in consequence of the alkaline anti- 
dotes administered all the acid will have been neutralized, 
and only sulphates be found in the vomit and in the stomach. 
In such a case it will be impossible for the toxicologist to 
prove by the analyses alone the fact of poisoning by sul- 
phuric acid, since in the ordinary contents of the stomach 
and bowels sulphates are always present. Consequently, 
further evidence of the poisoning must be sought for in 
the symptoms, post-mortem lesions, and attendant circum- 
stances. 

Detection of Stains on Clothing. — The color of the stains 
made by sulphuric acid on dark cloth is at first red and 
later brownish, and they may retain moisture for a long 
time. The moisture adherent to the charred hole made by 
this acid in clothing will distinguish it from one made by a 
heated body, which is always dry. To recognize the acid, 
a few of these spots should be cut out of the garment and 
boiled with a little distilled water and tested with the barium 
chlorid. A portion of the unaffected cloth should also be 
tested at the same time in order to show the absence of any 
sulphate. 

Quantitative Analysis, — Sulphuric acid is estimated as a 
sulphate; the precipitated barium sulphate, after careful 
washing in hot water, with a little hydrochloric acid, is col- 



NITRIC ACID. 405 

lected on a filter, dried, and weighed ; 100 parts of the sul- 
phate are equal to 42.02 parts of sulphuric acid (H2SO4). 

Nitric Acid (Aqua Fortis). — As found in commerce, this 
is a powerful acid, of a yellow or orange color. Sp. gr., 
1.35 to 1.45. It is apt to be contaminated with sulphuric 
acid, chlorin, iron, and various nitrogen oxids. It is seldom 
used as a poison. Orfila relates a case where a man poured 
this acid into the ear of his drunken wife, which caused her 
death by inflammation of the brain and destruction of the 
bones seven weeks afterward. This, however, might not 
be regarded as an instance of poisoning. 

Symptoms. — Similar to those caused by sulphuric acid, 
except that the lips, tongue, and inside of the mouth are 
stained yellow. Spots upon the cheeks, neck, and other 
parts of the body, and of the dress, are also yellow and very 
permanent. The teeth are white, but yellowish at their 
junction with the gums. The purging is sometimes accom- 
panied with blood. The vapors of this acid have caused 
death in seven instances. 

Fatal Dose. — Two drachms of the concentrated acid have 
proved fatal to an adult, although larger doses have been 
taken with impunity. Life is usually destroyed within 
twenty-four hours, but frequently it is protracted, and in 
one case death did not occur for seven months. 

Treatment. — This is essentially the same as that recom- 
mended for sulphuric acid. 

Post-mortem Appearances. — The lips, tongue, and inside 
of the mouth present a yellow or yellowish-brown appear- 
ance ; the mucous membrane of the esophagus is colored 
yellow, softened, and peels off in pieces ; the larynx and 
glottis may have suffered, as in the case of sulphuric acid. 



406 TOXICOLOGY. 

The stomach may be distended, presenting a greenish color, 
due to the action of the acid on the bile; it may be found 
in a pulpy state, perforated, and adherent to the adjacent 
viscera, and even partially destroyed. The contents have 
usually a yellow color ; the lining membrane is deeply con- 
gested and the vessels filled with dark blood; sometimes 
the open mouths of the vessels can be seen. The upper 
portions of the intestines may exhibit the same appearances 
as the stomach. The large intestine is apt to escape. In 
chronic poisoning there is great emaciation; and, after 
death, contraction of the pylorus, with softening of the 
mucous membrane, has been found. 

Analytic Methods. — The concentrated acid is recognized 
by (i) the odor when exposed to the air; (2) by leaving 
no residue when heated in a watch glass; (3) by giving off 
dense orange-red fumes when poured on fragments of cop- 
per (the dilute acid requires to be boiled on these metals to 
produce the same result) ; (4) by producing a brown color 
with a strong solution of ferrous sulphate. 

The dilute acid is tested as follows : ( i ) add barium 
chlorid and silver nitrate to separate portions of the sub- 
stance ; no precipitates will form. (2) Boil with fragments 
of copper; red fumes will be evolved. (3) Neutralize with 
potassium carbonate and moisten a piece of filtering paper 
in the resulting solution (potassium nitrate) ; when the 
paper is dried it will scintillate on burning, like touch-paper. 
(4) Evaporate the above solution until crystallization ; ex- 
amine the crystals with a magnifier (potassium nitrate forms 
six-sided striated prisms). If the solution be neutralized 
with sodium carbonate the crystals will present the cubic 
form of sodium nitrate. (5) Put a fragment of these crys- 
tals into a small test-tube along with a little copper filings 



NITRIC ACID ANALYTIC METHODS. 407 

and a few drops of sulphuric acid and water ; slightly heat, 
when there will be an escape of orange-red fumes and the 
production of a blue liquid (copper nitrate). (6) Proceed 
as in (5), but instead of copper filings add a fragment of 
morphin, when an orange-colored solution will result, the 
color becoming fainter on boiling. (7) As in (5), substitut- 
ing for the copper a crystal of brucin, which will yield a 
blood-red color, disappearing on the addition of stannous 
chlorid. (8) Proceed as in (5), except, instead of using 
copper filings, add an excess of sulphuric acid and allow it 
to cool ; then pour in gently a freshly-prepared solution of 
ferrous sulphate ; a brown color is immediately formed at 
the line of junction; if heated, the color disappears with 
the evolution of the orange-red fumes. (9) As in (5), using 
a crystal of narcotin instead of copper ; a reddish-brown 
color is produced, changing by gentle heat to a blood-red. 
(10) If a small portion of the crystals obtained in (4) be 
mixed with a solution of phenol in strong sulphuric acid, 
heated gently for a few minutes in a steam-bath, diluted 
with water, and neutralized by sodium hydroxid, a yellow 
solution of sodium picrate will be obtained. 

Toxicologic Exmnination. — First, test the organic matters 
(as contents of the stomach, etc.) with litmus paper; the 
acid may have been neutralized by the alkaline antidotes. 
If viscid, add a sufficient quantity of distilled water and boil 
gently for about a quarter of an hour ; filter ; if found to 
be acid, a trial test may first be made by boiling a portion 
of it in a test-tube with copper filings ; it may next be 
neutralized with potassium carbonate and crystallized by 
evaporation ; drench the crystals with strong alcohol to 
remove impurities, and test them by the methods above de- 
scribed. If the matters examined are not acid, but have 



408 - TOXICOLOGY. 

been neutralized by chalk or magnesia, the nitrates so pro- 
duced may be decomposed by potassium carbonate and the 
resulting potassium nitrate strained from the filtered so- 
lution. 

The urine should always be examined for nitrates by dis- 
tillation with sulphuric acid, neutralizing the distillate with 
potassium carbonate and proceeding as above. 

The tissues may be examined as follows : Make a mix- 
ture of equal parts of sulphuric acid and water, and put 
twenty or thirty drops into test-tubes. 

To (i) add a little brucin; no change should result. 
Add now a little piece of the tissue to be examined, when 
the solution, if nitric acid be present, will turn a blood-red 
color. 

To (2) add a few grains of copper filings and a piece of 
the tissue, and boil. The evolved reddish vapors, if nitric 
acid be present, will give a blue color to a piece of white 
paper moistened with a solution of potassium iodid and 
starch. 

To (3) add a solution of ferrous sulphate; on adding a 
piece of the tissue, the solution will become of an olive- 
brown color if nitric acid be present. 

Suspected stains are examined by soaking the fabric or 
other substance in warm distilled water. If acid, the solu- 
tion should be neutralized with potassium carbonate, and 
the resulting crystals treated as above directed. The color 
of these stains, as before mentioned, is yellow ; they can be 
distinguished from stains of iodin and bile by the applica- 
tion of a weak solution of potassium hydroxid, which in- 
tensifies the nitric stain, whilst it discharges the iodin (or 
bromin) stain, and does not affect the bile. 



HYDROCHLORIC ACID. 4O9 

Hydrochloric Acid. — This acid, known commercially 
as Muriatic Acid and Spirit of Salt, as usually found has a 
light yellow color, fumes when exposed to the air, is power- 
fully acid, and has a sp. gr. of about 1.15. When pure it 
is colorless ; its yellow hue is due to ferric chlorid or or- 
ganic matter. The commercial acid frequently contains 
arsenic and antimony and other impurities. Instances of 
poisoning by it are comparatively rare, except as the result 
of accident. 

Symptoms. — These are, generally, similar to those occa- 
sioned by the other mineral acids. A grayish or white 
appearance of the tongue and interior of the mouth, with 
the formation of a false membrane, is usually observed. 

Fatal Dose. — Half an ounce for an adult ; a drachm has 
destroyed a child. The fatal period varies from a few hours 
to many weeks. 

The treatment is the same as that above described for the 
other mineral acids. 

Post-mortem Appearances. — These, on the whole resem- 
ble the lesions found in cases of death from the other two 
acids, although they more closely assimilate the appearance 
produced by sulphuric acid, in the blackened or charred 
ridges often noticed in the interior of the stomach. The 
esophagus presents a denuded appearance from the detach- 
ment of its mucous membrane. The glottis and larynx 
may also be deeply injected and corroded in cases where 
the poison has spent its effects on these organs. 

Analytic Methods. — The strong acid is distinguished from 
other acids (i) by its yellow color; (2) by its giving off 
dense white fumes in contact with ammonium hydroxid, 
shown by holding the stopper of the ammonium hydroxid 
bottle over the solution supposed to contain the acid; (3) 
36 



410 TOXICOLOGY. 

by its negative action on copper or mercury, even when 
heated; (4) by its evolving chlorin when heated with man- 
ganese dioxid. 

The dilute acid is detected by a solution of silver nitrate, 
which gives a white, curdy precipitate of silver chlorid that 
soon darkens on exposure to light, is insoluble in boiling 
nitric acid, but very soluble in ammonium hydroxid. When 
dried and heated it fuses into a yellow liquid, which on 
cooling becomes a soft, horny mass. As any soluble chlorid 
— e. g., common salt — will yield the same precipitate with 
silver nitrate, a drop of the original solution should be 
evaporated on a glass slide ; if it was free acid it will all 
disappear ; if a chlorid, a residue will be left. 

Silver nitrate forms precipitates with other substances ; 
but all, with the exception of that from cyanids, dissolve in 
nitric acid. The silver cyanid is soluble in boiling nitric 
acid, and is further distinguished by its crystalline appear- 
ance, and by yielding, when heated, cyanogen gas. 

Toxicologic Examination. — As this acid is volatile, a dis- 
tilling process may be applied. The organic matters (such 
as the contents of the stomach, together with the viscera, 
properly cut up) should be put into a glass retort with a 
small quantity of pure water, and distilled nearly to dryness. 
The first portion of the distillate may be rejected, but the 
remainder will usually yield the characteristic Jtest with 
silver nitrate. 

The above method, however, is liable to two fallacies: 
First, there is always apt to be present in the gastric juice 
of the human stomach a variable quantity of hydrochloric 
acid ; and, secondly, sodium chlorid is frequently found 
there, being introduced with the food. Consequently, it 
will not be safe to rest the proof of poisoning by hydro- 



ALKALIES AND THEIR SALTS. 4 1 I 

chloric acid on the analysis exclusively. If the symptoms 
and post-mortem lesions do not indicate death from a cor- 
rosive acid, the mere detection of this acid, after death, by 
the chemical examination would be of no value. 

The stains of hydrochloric acid on dark cloth are at first 
of a bright red color, changing, after some days, to a red- 
dish-brown. They may be examined after the method 
already described. The experiment should, however, be 
verified by testing another portion of the garment not hav- 
ing a stain. 

This acid is sometimes used to erase ink marks in cases 
of forgery. The paper thus acted on should be treated in 
the same manner as mentioned for the cloth. 

Hydrochloric acid is estimated as silver chlorid, every 
100 parts of the latter are equivalent to about 80 parts (by 
weight) of acid of sp. gr. 1.15. 

ALKALIES AND THEIR SALTS. 

The toxicology of the three alkalies. Potassium Hy- 
droxid, Sodium Hydroxid, and Ammonium Hydroxid, 

may properly be considered together. Their effects upon 
the animal system are analogous, and resemble the impres- 
sions produced by the mineral acids, being powerfully 
caustic in their concentrated state. They attack the tissues 
with which they come in contact by virtue of their chemical 
affinities causing their disorganization and complete destruc- 
tion. They are very rarely used for homicidal poisoning, 
but they occasionally prove fatal as the result of accident. 

Potassium hydroxid is commonly known as caustic potash 
or potassa ; sodium hydroxid is known as caustic soda and 
concentrated lye. 

The Aqua Ammonice of the shops is a solution of ammo- 



41 2 TOXICOLOGY. 

nium hydroxid in water, and is a highly caustic substance. 
The first two alkahes, together with their salts, are fixed 
when heated; the latter is volatilized by heat, by which 
circumstance they are readily distinguished from each 
other. 

Symptoms. — In the concentrated state they occasion an 
acrid, nauseous taste, followed by a burning sensation in the 
throat and stomach; violent abdominal pain, increased by 
pressure ; vomiting of mucous matters, tinged with blood ; 
purging of a similar character, with tenesmus ; difficulty of 
swallowing, hoarseness, and coughing. The pulse is quick 
and feeble, the countenance anxious ; the body is covered 
with a cold, clammy sweat; the respiration is rapid, with 
great muscular protraction. Death may ensue in a few 
hours, or it may be postponed for months, or even years. 
In the latter cases the fatal result is often owing to sec- 
ondary causes, such as stricture of the esophagus and of the 
pylorus, occasioning starvation. 

The effects of swallowing strong ammonium hydroxid 
are similar to those above described, except that they may 
be more rapid, and affect the organs of respiration by the 
vapor given off. 

The incautious application of this vapor to the nose, in 
cases of syncope, is sometimes followed by fatal results for 
this some reason. 

Fatal Dose. — As in the case of the mineral acids, the fatal 
effects of the alkalies depend rather upon their degree 
of concentration than upon the actual amount swallowed. 
Half an ounce of potassium hydroxid is the usual fatal dose ; 
but an ounce and a half of the solution of the shops, con- 
taining about forty grains, has caused death. Strong am- 
monium hydroxid has proved fatal in the dose of two 



ALKALIES AND THEIR SALTS. 413 

drachms ; recovery has occurred after swallowing over an 
ounce. Instances of recovery are more frequent from this 
than from the fixed alkalies. 

Treatment. — The stomach-pump should never be used. 
Dilute vinegar or lemon juice should be freely given, 
together with oil or other demulcents. Opium may be 
used to quiet pain, and stimulants to counteract the de- 
pression. The inhalation of acetic acid might prove bene- 
ficial in poisoning by vapor of ammonium hydroxid. 

Post-mortem Appearances. — The lining membranes of 
the mouth, throat, esophagus, and stomach exhibit evi- 
dences of corrosion in their softened and abraded condition ; 
at times the mucous coat of the stomach is blackened from 
the effused blood, and may be completely destroyed. The 
larynx and bronchi may be inflamed and softened, espe- 
cially with ammonium hydroxid. In chronic cases the 
mucous membrane of the esophagus may be much thick- 
ened, and its caliber, as also that of the pylorus of the 
stomach, extremely contracted. 

Chemical Properties. — All the alkalies neutralize acids, 
turn turmeric paper browai, and restore the blue to red- 
dened litmus. They are not precipitated by hydrogen sul- 
phid, ammonium sulphid, or ammonium carbonate. Cor- 
rosive sublimate causes a yellowish precipitate with the 
fixed alkalies and a white one with ammonium hydroxid. 

Potassium hydroxid is distinguished from sodium hy- 
droxid as follows : 

I. Platinum chlorid produces, with the former, a yellow 
potassium platinum chlorid which, under the microscope, 
is seen to be in octahedral crystals. This reagent will also 
precipitate ammonium compounds ; hence, in an analysis, 
the absence of the latter must be insured. Ammonium can 



414 TOXICOLOGY. 

readily be detected by heating a little of the suspected 
liquid in a test-tube with lime or magnesia ; the vapor may 
be recognized by its odor and by its action on turmeric 
paper. 

2. Tartaric acid throws down from a strong solution of 
potassa, or its salts, a white crystalline precipitate — potas- 
sium acid tartrate. This action should be facilitated by 
adding a little alcohol and stirring with a glass rod. Here, 
also, the absence of ammonium compounds must first be 
proved. 

. 3. Neutralize the solution with nitric acid and evaporate 
on a steam water-bath. The resulting crystals are readily 
identified. Potassium "nitrate is in six-sided striated prisms ; 
sodium nitrate in cubes. 

4. Heated on a loop of platinum wire in the Bunsen- 
burner flame, potassium compounds give a violet flame, 
sodium compounds a yellow flame. The spectroscope 
easily distinguishes the two bodies in presence of each 
other. Sodium gives a yellow line, which is double when 
examined with a good instrument. Potassium gives two 
lines, one dark red and the other violet. 

Since sodium compounds occur abundantly in many 
animal fluids, especially blood and urine, and potassium 
compounds are also present, it is obvious that the finding 
simply ol these elements in combination will not prove 
poisoning. It must be shown either that the amount is 
much larger than normal or that compounds not normal to 
the body are present. 

Toxicologic Examinations. — If required to separate a 
hydroxid from the carbonate, the original mixture must 
first be evaporated to dryness, and the residue treated with 
absolute alcohol, which will dissolve out the hydroxid but 



TESTS FOR AMMONIUM SALTS. 415 

not the carbonate. After filtration, evaporate to dryness 
and incinerate ; dissolve the residue in water and test as 
above directed. 

Quantitative Determination. — Potassium is estimated by 
mixing its chlorid with excess of an alcoholic solution of 
platinum chlorid. The precipitate should be washed with 
strong alcohol, dried, and weighed. Every lOO parts of the 
double chlorid represents 23 parts of potassium hydroxid, 
or 28.3 parts of carbonate. 

Solution of ammonium hydroxid {Aqua Ammonice) is a 
colorless liquid having a very pungent odor and an acrid, 
alkaline taste. It leaves no residue when evaporated to 
dryness. It gives to a solution of a copper salt a charac- 
teristic blue color. It produces white fumes with hydro- 
chloric acid. 

The salts of ammonium are colorless, and volatilize when 
heated ; and if, at the same time, they are mixed with lime 
or potassium hydroxid, they yield the characteristic ammo- 
niacal odor. The other tests for ammonium salts are : ( i ) 
platinum chlorid; (2) tartaric acid; (3) Nessler's reagent. 
The last is made by adding an excess of potassium iodid to 
mercuric chlorid until the mercuric iodid formed is redis- 
solved, an excess being afterward added. It gives an 
orange or brownish discoloration, with the smallest trace of 
ammonium compounds. 

Toxicologic Examination. — If the mixture be in a state of 
decomposition, it will be useless to attempt the analysis, 
inasmuch as ammonium compounds are invariable as a re- 
sult of putrefactive processes. Distil over about a fourth 
of the organic liquid, conducting the vapors into a well- 
cooled receiver containing a little water, and test the solu- 
tion as above directed. If no ammonium hydroxid be given 



4 1 6 TOXICOLOGY. 

off, then examine the contents of the retort for an ammo- 
nium salt, by first treating with strong alcohol; filter, the 
solution and re-distil, along with- slacked lime or sodium 
hydroxid ; this will yield the ammonium hydroxid. 

Ammonia is determined, quantitatively, like potassium; 
every lOO parts of the double chlorid represent 16.5 parts 
of ammonium hydroxid, equivalent to about 40 parts by 
weight of common aqua ammonicF. 

Potassium Nitrate (Niter, Saltpeter). — This salt. is much 
used in the arts, especially for the manufacture of gun- 
powder; it is likewise employed in medicine in small doses. 
It occurs in six-sided, striated crystals ; taste saline and 
cooling; very soluble in water; deflagrates when thrown 
upon hot coals ; gives off nitrous fumes when acted upon by 
sulphuric acid. 

Symptoms. — In large doses, and in the concentrated state, 
it acts as a powerful irritant to the alimentary mucous mem- 
brane, causing violent burning pain in the esophagus and 
stomach ; vomiting, sometimes of blood ; bloody stools ; cold, 
clammy skin ; weak, frequent pulse ; collapse and death. Be- 
sides these evidences of a local irritant action, it occasions 
certain nervous symptoms, such as convulsions, tremors, 
partial paralysis, loss of speech, and delirium. Occasionally, 
a very large dose has produced comparatively slight local 
symptoms, while the impression upon the nervous centers 
has been more decided. 

Fatal Dose. — Death from this compound is generally the 
result of accident, it having been swallowed by mistake for 
other salts. An ounce to an ounce and a half, taken in a 
concentrated state, has frequently proved fatal in a few 
hours. The largest dose recorded to have been taken is 



POTASSIUM NITRATE. 4I7 

mentioned by Warton and Stille. A German, by mistake, 
swallowed three and a half ounces of this salt. He com- 
plained of but slight pain or sense of heat in the stomach, 
and was purged three times within three or four hours. 
About five hours after taking the niter he suddenly fell out 
of his chair and expired. There was no autopsy. In this 
case the excessive dose of the poison seemed to have de- 
stroyed life by shock. The rigor mortis was very im- 
perfect, and the countenance and lips retained their life- 
like appearance to a remarkable degree for three days after 
death. 

Post-mortem Appearances. — The lining membrane of the 
stomach is usually highly inflamed and detached in places ; 
perforation has been observed in one instance. The in- 
testines are often similarly affected. The contents of the 
stomach are sometimes tinged with blood. 

Treatment. — Free vomiting should be promoted by the 
use of bland mucilaginous drinks ; opium and stimulants 
to relieve pain and depression ; together with external appli- 
cations, as fomentations, etc. There is no chemical antidote. 

Toxicologic Examination. — See Nitric Acid. — According 
to Orfila and Wohler, niter has been detected in the urine, 
liver, spleen, and kidneys of those poisoned by it. 

Potassium Chlorate. — This salt, so much used in medi- 
cine of late years, has not infrequently been the cause of 
death. Half an ounce has proved fatal to an adult. The 
symptoms are those of a powerful irritant to the alimentary 
canal and nervous systems, such as vomiting and purging, 
general weakness, with rigidity of the limbs, delirium, and 
coma. After death the blood has been found of a brown- 
ish color, thickened, with a tendency to agglutination of 



41 8 TOXICOLOGY. 

the corpuscles. The urine contains blood corpuscles and 
brownish tube-casts. It has been stated that crystals of 
the substance has been found in the tubes of the kidney 
in cases of poisoning. 

A case of cumulative poisoning by potassium chlorate 
was reported by Dr. L. W. Day, of Minneapolis {Jour. 
Amer. Med. Assn., July 22, 1905). A man aged 30 took 
50 5-grain tablets of potassium chlorate, in the interval be- 
tween March 19 and April i. A tablet was dissolved in 
water and taken from time to time as convenient. During 
the night of April 2 he suffered from itching, and next day 
the examination by the physician showed a petechial erup- 
tion over the thighs, legs, ankles, trunk, forearms and 
wrists, with raised reddish macules. These macules soon 
coalesced, the color becoming more brilliant, indicating 
hemorrhage. There was no nausea, diarrhea or headache. 
The blood was unusually bright red ; the red cells were 
5,016,000. The urine was 1040, scanty, rather high-colored, 
but with no abnormal deposit, and only a trace of albumin. 
The patient recovered slowly without treatment and without 
important incident. 

Potassium Acid Tartrate {Cream of Tartar). — This salt 
is very much used in medicine and is not generally con- 
sidered to be poisonous ; but in large and concentrated doses 
— two ounces — it has proved fatal, causing symptoms 
strongly resembling those produced by niter. 

Alum. — This salt, in large doses, is very irritant to the 
stomach and bowels, producing vomiting and purging, al- 
though in small quantities its action is that of an astringent. 
It has proved fatal to animals, and at least one death in the 



POTASSIUM SULPHATE. 4I9 

human subject has been recorded. Commercial akim may 
be either potassium akiminum sulphate or ammonium 
aluminum sulphate. The physiologic action of each is 
practically the same. 

Potassium sulphate and potassium acid sulphate are 
highly irritating in large doses ; the former has occasioned 
death in quantity of ten drachms. It is used sometimes as 
an abortive. Arsenic compounds have been found as im- 
purities of the commercial article, and might in this way get 
into Dover's powder when made by the older method, in 
which a large proportion of potassium sulphate was used. 
The death of a sailor occurred some years ago on a German 
steamer bound for Philadelphia, and on arrival of the vessel 
the German consul requested the captain to submit to Dr. 
Henry Leffmann, for analytic examination, all suspicious 
materials found among the sailor's effects. About half a 
pound of potassium acid sulphate was found, and it is not 
unlikely that some of this substance had been taken, possibly 
by mistake, although there was suspicion of suicide. The 
symptoms were those of an irritant. 

Large doses of the ordinary purgative salt under certain 
circumstances may prove powerfully irritating, and even 
fatal. Instances of death following the administration of 
overdose of Epsom salt and common salt are reported by 
Christison and Taylor. 

Chlorinated Soda and Potassa. — Known in commerce 
as Labarraque's solution and Javelle water, respectively, and 
much used for disinfecting and cleansing purposes, have 
occasionally produced fatal effects when swallowed. Tar- 
dieu has reported such a case in which a child died some 



420 TOXICOLOGY. 

weeks after taking this substance in divided doses. It was 
identified by the discovery of an abnormal quantity of 
sodium chlorid in the urine and kidneys ; also by the for- 
mation of lead chlorid on the leaden mouth-piece of the 
bottle which contained the poison, and likewise by charac- 
teristic stains of a reddish-white color on the child's cap. 

Sodium Fluorid. — This is a white powder, soluble in 
water. It is noted here because it is now freely sold for 
the destruction of kitchen vermin, being spread on shelves 
and floors. It may easily be mistaken for starch, flour or 
sugar, and thus be a cause of poisoning. It will probably 
act as a corrosive irritant, producing painful inflammation of 
the stomach. Emetics or washing out of the stomach would 
not be advisable. As calcium fluorid is insoluble, the chem- 
ical antidote would be the administration of some calcium 
compound, but unfortunately most of these are either irri- 
tant or too feebly soluble to be of prompt effect. 

The administration of about a teaspoonful of sirup of 
lime (U. S. P., 1900) in much water might have antidotal 
value. Milk and eggs should be given. 

Barium Salts. — All the soluble compounds of barium are 
poisonous. They occasion symptoms analogous to those 
caused by potassium nitrate, such as pain in the stomach, 
vomiting, and purging, with decided nervous symptoms and 
palpitation of the heart. The post-mortem lesions are in- 
flammation of the mucous coat of the stomach and bowels, 
great congestion of the brain and lungs, and the heart full 
of dark blood. 

The proper treatment is to promote the evacuation of the 
poison by the use of emetics and mucilaginous drinks and 



PHOSPHORUS — SYMPTOMS. 421 

the free administration of sodium sulphate or magnesium 
sulphate, and the subsequent use of antiphlogistic remedies. 



IRRITANTS PROPER. 

This subdivision of the Irritants includes such poisons 
as, besides producing inflammation of the gastro-intestinal 
mucous membrane, cause other symptoms, which indicate 
an impression on the great nervous centers. Several of the 
alkaline and earthy salts already described are of this char- 
acter, and might have been considered under this head. 

PHOSPHORUS. 

Phosphorus, in combination, is largely diffused as a con- 
stituent of the animal body. Its presence is essential to 
the performance of its normal functions, and this is espe- 
cially true in reference to the great nerve-centers, of which 
it constitutes a comparatively large proportional part. It 
is eliminated from the system in the urine in the form of 
phosphates. 

In its free state phosphorus is a powerful irritant poison. 
It is less employed for poisoning in this country and Eng- 
land than in France and Germany, and is seldom used for 
homicidal purposes. Fatal results have frequently oc- 
curred by its accidental and suicidal employment — chiefly 
the former, from the swallowing of phosphorus-paste (used 
for destroying vermin) and the tops of lucifer matches. 

Symptoms. — These do not usually appear for some hours 
after the poison has been taken ; but in some cases they are 
manifested earlier. There is first perceived a disagreeable 
taste, and a garlicky odor may be noticed in the breath. 
This is followed by a burning pain in the throat and stom- 



422 TOXICOLOGY. 

ach, with intense thirst and nausea; distention of the abdo- 
men, with vomiting and purging; pupils dilated; cold 
perspiration and great anxiety, with small, frequent, and 
irregular pulse. The matters first vomited generally ex- 
hale a garHcky odor, and are luminous in the dark; their 
color is green, or like coffee grounds and they may contain 
the blue or red fragments of the tops of matches. The dis- 
charges from the bowels have also been observed to be 
phosphorescent. Sometimes convulsions precede death; 
again, the patient . may die quietly or in a coma. If the 
case is protracted for some days, jaundice is apt to occur, 
and likewise hemorrhage from the stomach, bowels, nose, 
and other parts of the body. In some of its phases the 
hemorrhagic form resembles scurvy, and, as in the latter 
disease, there are purpura spots over the body. Paralysis 
is an occasional result. The urine is highly albuminous, 
and is apt to be suppressed. 

■ Chronic poisoning, accompanied by all the above symp- 
toms, though in a less violent degree, may result from the 
inhalation of the vapors of phosphorus in the manufacture 
of lucifer matches. This form of poisoning comes on very 
insidiously, and is very apt to be fatal. It generally mani- 
fests itself first in the jaws, causing first an inflammation of 
the periosteum, followed by caries of the teeth and necrosis 
of the bone. Some authorities state that this form of ne- 
crosis attacks only those whose teeth are decayed. It is 
further stated that in some match factories it is required 
that the workmen should have sound teeth. 

Vollbracht furnishes notes of a case of poisoning by 
phosphorus in which symmetrical gangrene of the feet 
developed. Death soon followed. The patient was a young 
woman who had taken a mixture intended for tipping 



PHOSPHORUS TREATMENT. 423 

matches. A^ollbracht refers to a case reported by Kolisko 
in which subacute poisoning by phosphorus was followed by 
gangrene of the extremities. In judging of these cases, it 
must not be forgotten that a mixture used for tipping 
matches may contain other poisonous bodies besides phos- 
phorus. 

Fatal Dose. — Less than a grain has proved fatal. Lobel, 
of Jena, has reported the case of a lunatic who died from 
taking about the yV of a grain. A child died after sucking 
two matches ; another older child died from the effects of 
swallowing the tops of eight matches. 

Phosphorus is occasionally employed in medicine, in 
doses of ^V ^o 3V o^ ^ grain ; but even in these small doses 
its effects are uncertain, and it may sometimes act with 
unexpected severity. 

Fatal Period. — It is not to be classed among the rapidly 
fatal poisons. It usually causes death in from one to four 
or five days ; in exceptional cases, earlier. Casper quotes 
the case of a young lady who died in twelve hours after 
swallowing three grains of phosphorus in the form of an 
electuary. Dr. Habershon reports a case which proved 
fatal in half an hour. Cases of chronic poisoning may last 
for months, or even for years. 

Treatment. — There is no chemical antidote known. Free 
emesis should be encouraged by the use of albuminous and 
mucilaginous drinks holding magnesia or magnesium hy- 
droxid in suspension. Washing out the stomach with' water 
containing a little potassium permanganate (i to 3 per cent.) 
is recommended. The use of fatty oils is objectionable, 
as they are solvents for phosphorus, and would conse- 
quently tend to diffuse the poison. Oil of turpentine is 
highly recommended by Dr. Percy as a reliable antidote, if 



424 TOXICOLOGY. 

given early and before the poison is absorbed. The old oil, 
or that which has become oxygenated, is to be employed, 
not the fresh hydrocarbon. He also recommends the intro- 
duction of oxygenated water into the stomach through a 
tube, and the inhalation of free oxygen into the lungs. 
Animal charcoal has also been recommended, from its 
power of absorbing free phosphorus ; and likewise silver 
nitrate, from its power to form an insoluble compound of 
silver and phosphorus. Copper sulphate also is recom- 
mended. These mineral salts are themselves irritant poisons, 
and can certainly be permissible only in small doses. 

Post-mortem Appearances. — According to Tardieu, who 
has given special attention to this subject, the lesions pro- 
duced by phosphorus vary according to the form in which 
it is taken. It is when in the pure state or simply dissolved 
in oil that it most frequently occasions lesions in the esoph- 
agus and alimentary canal. Fragments of phosphorus 
may be discovered adhering to the mucous membrane, even 
of the large intestines, and at these spots the bowel is liable 
to perforation during the examination. In the esophagus, 
stomach, and intestines ecchymotic or gangrenous spots are 
scattered about. The mesenteric glands are engorged, and 
are often soft and friable. 

The blood corpuscles undergo, in phosphorus-poisoning, 
a speedy disintegration, which is doubtless the cause of the 
ecchymoses seen upon the different organs. 

In other cases, as in poisoning by phosphorus-paste, there 
may be no special morbid appearance, but even in the 
absence of redness or ulceration there will be ecchymoses, 
more or less abundant, over the mesentery and visceral 
peritoneum. The pleural and pericardial sacs contain 
bloody serum. Irregular bloody spots are scattered over 



PHOSPHORUS TREATMENT. 425 

the pleura, pericardium, and even the endocardium. The 
heart is soft, distended, or contains fluid blood. The blood 
itself is very dark, fluid and syrupy ; it appears to be com- 
pletely devitalized; the corpuscles are disintegrated and 
transparent, by loss of their coloring matter. In certain 
cases the mucous coat of the stomach and duodenum is so 
softened as to break under pressure of the knife ; ulcera- 
tions also sometimes occur in the stomach. It is stated that 
the intestines, and even the flesh, of animals poisoned by 
phosphorus have the odor of garlic, and appear luminous in 
the dark. This luminosity of the viscera has been observed 
in the human subject. 

The exterior of the body often exhibits an icterode ap- 
pearance. Sometimes the red or blue coloring matter of 
the lucifer matches that have caused death may be found 
adhering to the inside of the alimentary canal a considerable 
time after death. The general appearance of the gastro- 
intestinal mucous membrane is hemorrhagic rather than 
inflammatory, ecchymoses being scattered throughout. The 
contents of the intestines are liquid and bloody. The blad- 
der contains bloody urine, and often presents submucous 
ecchymoses. 

A peculiar pathological alteration revealed by the micro- 
scope as the result of phosphorus-poisoning is fatty degen- 
eration of the liver and other organs of the body. But 
these peculiarities are not absolutely characteristic of this 
poisoning, since they occur in poisoning by other agents, 
as arsenic, alcohol, antimony, etc., and also as the result of 
disease ; nevertheless, they possess especial importance from 
their association with other notable symptoms of phosphorus- 
poisoning, such as the jaundice, muscular pains and weak- 
ness, diseased condition of the blood, and albuminous urine. 
37 



426 TOXICOLOGY. 

The contents of the stomach in some instances evolve the 
odor and fumes ; and in a case mentioned by Casper, two 
days after death luminous vapors issued from the vagina, 
and a whitish vapor having a phosphorous odor issued from 
the anus. In this instance no smell or vapor of phosphorus 
could be detected on opening the stomach; nor was there 
any part of its lining membrane either softened or corroded. 

Diagnosis. — Generally, in acute cases, there will be no 
difficulty in recognizing the evidences of phosphorus-poi- 
soning, both from the symptoms and post-mortem lesions, 
as above detailed. Chronic cases accompanied by jaundice 
might, however, be mistaken for yellow atrophy of the liver. 
The following are diagnostic points : The sensation of heat 
in the throat, eructations and vomiting of matters having 
a garlick odor and a luminous appearance, would indicate 
phosphorus-poisoning. The icterode appearance is not so 
intense in the poisoning as in the disease, nor is it accom- 
panied with the injection of the eyes or with the fever 
which mark the latter. The fatty change of the viscera 
may be seen two days after the ingestion of the poison. 
According to other authorities, the liver in phosphorus- 
poisoning is enlarged, dull in appearance, doughy, uniformly 
yellow, with the acini well marked; in acute atrophy, the 
liver is diminished in size, greasy on the surface, of a dirty 
yellow color, and the acini nearly obliterated. In the 
former, also, the hepatic cells are either filled with oil glob- 
ules or entirely replaced by them ; in the latter the cells are 
filled with a fine granular detritus and thin structure, re- 
placed by a newly-formed connective tissue. 

Chemical Analysis. — Phosphorus is a white, waxy solid, 
nearly twice as heavy as water, readily fusible and inflam- 
mable. It evolves fumes at ordinary temperatures when 



PHOSPHORUS — TOXICOLOGIC EXAMINATION. 42/ 

exposed to the air, and appears luminous in the dark. The 
smell and taste of phosphorus recall those of garlic, by 
which means it may be easily recognized when mixed with 
food and drinks. The fuming of phosphorus in the air, as 
also its luminosity, is completely prevented by the presence 
of alcohol, ether, chloroform, oil of turpentine, and other 
bodies, even in minute quantities. Although insoluble in 
water, phosphorus ultimately imparts to it poisonous prop- 
erties. It is tolerably soluble in fixed and volatile oils by 
the aid of heat ; also in ether, chloroform and naphtha ; its 
best solvent is carbon disulphid. Nitric acid converts it 
into phosphoric acid. It is not affected by either sulphuric 
or hydrochloric acids. It is preserved under water, to pro- 
tect it from oxidation. 

In its free state phosphorus is easily detected by its 
sensible properties, as already described. A fragment put 
into the materials for generating hydrogen will evolve hy- 
drogen phosphid, easily recognized by its luminosity in 
the dark, and from being sometimes spontaneously inflam- 
mable. The gas, when ignited at a jet, burns with a green- 
ish-blue flame; when it is passed through a solution of 
silver nitrate, the latter is blackened by the production of 
silver. Phosphoric acid is formed in the solution, and may 
be detected by the appropriate reagents. 

Toxicologic Examination. — If the materials evolve whitish 
fumes, which are luminous in the dark, and have an allia- 
ceous odor, there can be no doubt of the presence of phos- 
phorus. If the mixture be ammoniacal, from putrefaction, 
sulphuric acid must first be added until the liquid is slightly 
acid. Sometimes the particles of phosphorus may be sepa- 
rated mechanically from the inside of the stomach and 
bowels, which, when found, should be carefully washed and 



428 TOXICOLOGY. 

set aside. Or the mass may be spread out on a metallic 
plate and gently heated over a spirit-lamp, when the minute 
fragments of phosphorus will take fire and burn with a bril- 
liant light. The suspected particles may be heated under 
water, when they will melt and run together into a glob- 
ule, which will solidify on cooling, and may easily be 
identified. 

Carbon disulphid may be used to dissolve out the phos- 
phorus from many organic mixtures, and when phosphorus- 
paste has been employed. On allowing the solution to 
evaporate spontaneously, the phosphorus will remain in 
minute globules, which can readily be examined. If, how- 
ever, the poison is in solution, or in too minute a quantity 
for the above tests, it must be examined by the following 
processes : 

Method of Mitscherlich. — The suspected liquid, acidi- 
fied by sulphuric acid, is to be distilled in the dark, and the 
vapors conducted through a long glass tube kept cold, the 
end of which passes into a receiver. On gently heating the 
retort or flask, the vapors, as they pass through the cold 
tube, condense and display a distinct luminosity. The 
phosphorus thus distilled collects with the aqueous vapor 
in the receiver to which it imparts the usual garlicky odor. 
A portion of it, if in sufficient quantity, may likewise collect 
in the receiver in the form of globules. This test is exceed- 
ingly delicate and satisfactory. Taylor states that the head 
of one lucifer match produced a luminosity which continued 
for half an hour in the condensing tube. 

The presence of solid phosphorus in the distillate would 
render further experiments unnecessary; but in the absence 
of any granules the distillate, after filtration, should be acidi- 



MARSH S TEST. 429 

fied by nitric acid, which will convert any phosphorus into 
phosphoric acid; the liquid should then be concentrated by 
evaporation and tested. If no luminosity has been observed 
the presence of a small amount of the compounds of phos- 
phorus in the distillate is not sufficient to warrant the suppo- 
sition of poison, since these might have been derived from 
the food or tissues and carried over mechanically. It should 
be remembered that it is only free phosphorus that gives out 
the luminosity by the above process ; the distillation of the 
brain, or any other tissue that contains this substance in 
combination, never produces it. 

Method of Lipowitz. — This consists in boiling the sus- 
pected liquid, slightly acidulated with sulphuric acid, with 
fragments of sulphur, in an apparatus similar to that em- 
ployed in the method of Mitscherlich, the experiment being 
conducted in the dark. The sulphur abstracts the phos- 
phorus from even complex mixtures, and combines with it. 
The boiling is continued for about half an hour, after which 
the pieces of sulphur are withdrawn and washed in water. 
They will now emit the peculiar odor of phosphorus, and 
appear luminous in the dark. On gently heating them with 
nitric acid, a mixture of phosphoric and sulphuric acids will 
result. By evaporating this solution to near dryness to get 
rid of the sulphuric acid, then diluting and filtering, the 
phosphoric acid may be recognized by the usual tests. In 
prosecuting this test, unless the amount of phosphorus is 
very minute, the luminosity of the vapor may also be 
observed in the cool tube. 

Marsh's Test. — This process is based upon that em- 
ployed in testing for arsenic. The suspected material, 
properly prepared, is put into the jar containing the mate- 
rials for generating hydrogen ; the resulting gas is then 



430 TOXICOLOGY. 

passed over calcium hydroxid, for the purpose of removing 
any hydrogen sulphid; it is then ignited at the end of the 
delivery tube, producing a green flame. The phospho- 
retted hydrogen is luminous in the dark, and affords a 
black precipitate with silver nitrate. 

Phosphorus has been detected in the free state as late 
as three weeks after death; but it is very apt to become 
oxidized in the body, in which case it can only be identified 
as phosphate. 

The method of testing for phosphorus, as phosphates, 
in a case of suspected poisoning is unsatisfactory, since 
these salts always exist in association with the tissues and 
secretions, as well as in many articles of food. The mode 
of procedure in such a case is to treat the mixture with a 
little pure nitric acid, and concentrate by evaporation. It 
is then treated with a slight excess of pure sodium carbon- 
ate and evaporated to dryness, and fused in a porcelain 
crucible. The resvilting sodium phosphate may then be 
tested as follows: 

1. Silver nitrate throws down yellow silver phosphate, 
soluble in ammonium hydroxid and in nitric and acetic 
acids. Hydrochloric acid converts it into the white chlorid. 
Silver nitrate also gives a yellow precipitate of silver ar- 
senite with arsenites, which behaves in the same manner 
as the phosphate ; they are distinguished by drying, and 
heating in a reduction tube ; silver arsenite yields a ring of 
sublimed octahedral crystals. 

2. Ammonium chlorid and magnesium sulphate. — This 
mixture gives with a phosphate a characteristic crystalline 
precipitate of ammonium magnesium phosphate; the mi- 
nutest quantity can be identified by the microscope. 

3. Ammonium Molybdate. — This reagent produces a 



lODIN — SYMPTOMS. 43 I 

yellow, pulverulent precipitate of ammonium pliosphomolyb- 
date ; it is insoluble in the strong acids, but soluble in alka- 
line phosphates, alkalies, and alkaline carbonates. 

Red, Amorphous, or Allotropic Phosphorus. — This sin- 
gular variety of phosphorus is procured by exposing ordi- 
nary phosphorus to a heat of 450° F. for a number of 
hours in an atmosphere deprived of oxygen, when it will 
change to a brick-red mass, totally unlike the ordinary sub- 
stance, although retaining its original composition. The 
difference between the two is shown by reference to the fol- 
lowing table : 

Common Phosphorus. Red Phosphorus. 

Very poisonous. Very slightly poisonous. 

Evolves a strong odor. Nearly odorless. 

Phosphorescent. Not phosphorescent. 

Melts at 108° F. Melts at about 500° F. 

Transparent. . Opaque. 

Almost colorless. Varies in color from a reddish- 
black to crimson. 

Freely soluble in some liquids. Nearly insoluble in all liquids. 

Flexible. Brittle. 

Oxidizes in the air. Unalterable in the air. 

Unites readily with other ele- Is acted on by other elements 

ments. with difficulty. 

Nitric acid acts on it with great Nitric acid produces no effect. 

energy. 

lODIN, BROMIN, AND CHLORIN. 

lodin occurs in shiny, dark, iron-gray scales ; it has a 
peculiar odor and disagreeable taste ; when heated it gives 
off beautiful violet-colored fumes, which are irritating to 
the nostrils and throat. Sparingly soluble in water, very 
soluble in alcohol and ether, and also in the aqueous solu- 
tion of potassium iodid. It is used medicinally in the form 
of tincture, compound tincture, and ointment. 



432 TOXICOLOGY. 

Symptoms. — Like phosphorus, iodin produces a local 
irritant effect and a remote influence ; the latter the result 
of using it in small quantities. In large doses it occasions 
burning heat in the throat ; severe pain in the abdomen ; 
vomiting and purging, the vomited matters having the 
peculiar odor of iodin, sometimes mixed with blood; the 
color of the matters is yellowish, except when they consist 
of farinaceous articles, in which case it is blue. The bowels 
may also exhibit the presence of iodin. Other symptoms 
are giddiness, headache, thirst, anxiety, convulsions, and 
fainting. 

In chronic poisoning (iodism) the symptoms are nausea, 
vomiting, purging, pain of stomach, tremors, palpitation, 
salivation, cramps, general emaciation, and a tendency to 
absorption of certain glands, especially the testes and the 
mammae. 

There is a remarkable diversity in the effects of iodin 
upon the human system, some persons bearing very large 
doses with little or no suffering, while others are seriously 
affected by the smallest quantities. Overdoses have occa- 
sionally proved fatal, leaving morbid appearances very 
similar to those produced by the irritant alkaline salts. 

Chemical Analysis. — In its free state, iodin may readily 
be distinguished by its solid form, color, odor, volatility, 
and its action on boiled starch — quickly turning it blue. 
When in combination as potassium iodid, the iodin must 
first be set free (by chlorin or nitric acid), and then the 
starch-test applied. 

From organic mixtures the iodin may be separated by 
like use of carbon disulphid or chloroform, which dissolve 
it; watery liquid should be separated and the solvent evap- 
orated at a very low temperature, when the iodin will be left. 



BROMIN. 433 

If this process fails, on account of the conversion of the 
iodin into hydriodic acid or into an iodid, it will be advisable 
to transmit hydrogen sulphid through the mass, properly 
diluted ; this will convert any free iodin into hydriodic acid ; 
then drive off the excess of gas by heat, add potassium 
hydroxid in excess, filter, and evaporate to dryness. Char 
the residue at a low red heat, to get rid of the organic mat- 
ter ; pulverize and dissolve in water. Concentrate the solu- 
tion, and add strong nitric acid and boiled starch, which will 
develop the iodin, if any be present. 

Potassium Iodid. — Although much used in medicine, in 
large doses it occasionally produces violent effects upon the 
system, such as headache, griping abdominal pains, thirst, 
inflammation of the nostrils and eyes, and frequent pulse, 
together with salivation and a pustular eruption. As found 
in the shops, it is apt to be considerably adulterated with 
carbonate. 

Bromin. — This is a dark-red, volatile liquid, excessively 
pungent to the eyes and respiratory organs, having an acrid 
odor and taste. It is highly corrosive, destroying animal 
tissues very rapidly. It has occasionally proved fatally 
poisonous. A case is reported by Dr. Sayre, of New York, 
of a daguerreotyper who swallowed an ounce of bromin for 
the purpose of self-destruction. The immediate symptoms 
were spasmodic action of the muscles of the larynx and 
pharynx, with great difficulty of breathing, followed by in- 
tense burning pain in the stomach, with great anxiety, 
restlessness, and trembling of the hands. The pulse was 
rapid, tense, and corded, and respiration greatly hurried. 
Collapse soon followed, and deatn took place in seven and 
a half hours after swallowing the poison. 
38 



434 TOXICOLOGV. 

The post-mortem examination revealed vivid injection of 
the external coat of the stomach and of the abdominal 
viscera generally, which were stained of a deep yellow color. 
Portions of the stomach were softened. Its contents resem- 
bled port-wine dregs, and exhaled the odor of bromin. Its 
whole interior was covered with a thick, black layer, resem- 
bling coarse tanned leather. The mucous membrane was 
very thin and very deeply injected. 

Chemical Analysis. — Bromin may be separated from 
organic matters by means of carbon disulphid or by ether 
after the method described for iodin. The bromids may be 
decomposed by chlorin or by a strong acid. Bromin im- 
parts a deep yellow color to boiled starch. 

Chlorin is a powerfully irritating gas, of a greenish- 
yellow color. If inhaled it may destroy life. Chlorin is 
readily recognized by its smell and color, and especially by 
its powerful bleaching properties. 

Chlorin Oxids. — The following instance occurred in Ger- 
many. A society of artists had for some time been using 
a small room for exposures by flashlight. A member who 
entered the room afterwards was found therein unconscious 
in which condition he remained for two hours after removal 
to his home. The pulse was weak. Consciousness slowly 
returned and was followed by persistent vomiting. There 
was pain in the back of the head and in the temporal region, 
with numbness in the forearms, hands, legs and feet. Sight 
was much enfeebled. The pulse was for some time not 
above 50 and there was much bronchial catarrh. After 
the patient had perceptibly improved, a careful examination 
showed marked symmetrical mydriasis and paralysis of the 
left abducens muscle. Both crystalHne lenses were turbid 



ARSENIC. 435 

in the equatorial region with intervening light and dark 
stripes, and diffuse turbidity in the center. The patient still 
complained of headache, numbness in the hands and formi- 
cation in the fingers. A marked bronchial catarrh also ex- 
isted with a pulse of lOO, but finally the normal condition 
was restored, stimulants and protecting spectacles being 
employed. 

An analysis of some of the flashpowder showed that it 
was composed of equal parts of powdered magnesium and 
potassium chlorate, and probably emitted chlorin oxids in 
the explosion. 

ARSENIC 

The term Arsenic, as employed in toxicology, always 
signifies, unless specially qualified, arsenoiis oxid, often, 
though erroneously, called arsenous acid. The element 
itself, which is rarely used as a poison, is brittle, of a steel- 
gray color, volatile when heated, its vapor having a strong, 
garlicky odor, by which it may be recognized. It is sold, 
however, under the name of fly powder, which is a mixture 
of the metal and arsenous oxid. It is rather an abundant 
element, and occurs in a number of minerals. 

Arsenic is one of the most important of all the poisons. 
The facility of procuring it and its ease of administration 
contribute greatly to its extensive use both as a homicidal 
and suicidal agent. Under the name of '' Rough on Rats " 
it is extensively used for the destruction of vermin. 

In the arts arsenic finds many uses, as in the manufacture 
of enamel and glass, composition candles, vermin-killers, 
dyes, and colors, etc. It is used in various alloys, as spec- 
ulum metal, white copper, and shot ; also by shipbuilders to 
protect timber from worms; farmers use large amounts of 



436 TOXICOLOGY. 

arsenical compounds for destroying plant parasites. One 
of the most common anilin colors, anilin red, fuchsin or 
magenta, is sometimes made by the aid of arsenic acid, and 
hence may contain notable amounts of the element. The 
inhabitants of Styria and other mountainous countries use 
arsenic to increase their powers of endurance. Preparations 
containing small amounts of arsenic are sold for improving 
the complexion. Numerous cases of slow poisoning by 
arsenic occurred in 1900 in England. The symptoms were 
principally a peripheral neuritis, and were traced to the 
presence of arsenic in brewing-sugars which had been made 
by the use of arsenical sulphuric acid. 

Properties of Arsenous Oxid. — It occurs in commerce 
either as a heavy white powder or in masses, which are at 
first translucent but afterward become opaque. It is nearly 
tasteless. It is slightly soluble in cold water, and there is 
some difference between the solubility of the crystalline and 
of the opaque varieties ; boiling water dissolves it more 
freely, but still not in large amount. Its solubility is much 
increased by the addition of an acid or an alkali, but dimin- 
ished by the presence of organic matter. It is easily held 
in suspension in soups, coffee, tea, or milk. 

When arsenous oxid is heated to a temperature near 
400° F., it sublimes in the form of a white vapor, which 
is inodorous, and is deposited on a cool surface, either as 
an amorphous powder or in octahedral crystals. If thrown 
upon red-hot charcoal it is decomposed, and the vapor will 
have a garlicky odor. 

Symptoms. — The rapidity and virulence of the symptoms 
depend somewhat on the form of the poison {i. e., whether 
in solution or otherwise), and also on the condition of the 
stomach. As a rule, the symptoms do not occur for half 



ARSENOUS OXID — SYMPTOMS. 437 

an hour or an hour. There is first a sense of faintness 
attended with a feeling of heat and constriction of the 
throat, together with thirst, nausea, and burning pain in 
the stomach, increased by pressure. Vomiting and retching 
soon follow ; the matters ejected are rarely streaked with 
blood ; they may be variously colored. Purging accom- 
panied with tenesmus comes on, and along with the vomit- 
ing may be incessant, though affording no relief to the 
sufferer. Cramps in the legs are apt to be present, along 
with great depression, cold sweat, intense thirst, and a feeble, 
frequent pulse. The whole train of symptoms may re- 
semble a severe case of cholera morbus, for which it has 
frequently been mistaken. As a rule, the symptoms are 
continuous, although there are occasionally remissions and 
even intermissions. Coma, paralysis, and convulsions may 
supervene before death. The urine is often partially sup- 
pressed. If the patient recovers from the immediate at- 
tack, he may suffer for a long time after from indigestion, 
partial paralysis, or from epilepsy. 

Certain anomalies may occur. The pain may be absent 
or slight. Occasionally, there is a remarkable absence of 
symptoms. Vomiting and purging and thirst may not be 
present. Some cases especially resemble cholera morbus 
from the intensity of the gastro-enteric irritability, while 
others indicate severe nervous disturbance by the intense 
headache, giddiness, restlessness, violent cramps, delirium, 
convulsions, and coma. Again, there may be immediate 
collapse, little or no pain, vomiting, or purging, but a cold, 
clammy skin, extreme prostration, very frequent and feeble 
pulse, slight coma, with perhaps convulsions and death 
within a few hours after swallowing the poison. In a few 
cases the symptoms have resembled those of narcotics, pro- 



43 S TOXICOLOGY. 

found sleep, deepening into coma, and death in a few hours 
without rallying. In the latter cases the autopsy may show' 
inflammation of the stomach. 

The symptoms of chronic poisoning usually result from 
small doses of arsenic frequently repeated, or from exposure 
to the vapors of arsenical products, as in the case of work- 
men, or from the accidental inhalation of arsenical dust 
from wall papers. The eyes and nasal mucous membrane 
become inflamed and watery, there is great gastric distress, 
with frequent sickness and vomiting, diarrhea, headache, 
and giddiness, a jaundiced skin, an eczematous eruption, 
local paralysis, general emaciation, falling out of the hair, 
salivation and excoriation of the tongue with hemorrhage ; 
and death may occur from exhaustion. The symptoms in 
such a case are frequently very obscure and misleading, and 
perhaps chance alone may reveal the real source of the dis- 
order. 

The time when the symptoms appear varies considerably. 
As before stated, these do not generally manifest themselves 
for half an hour or an hour after swallowing the poison ; but 
there are numerous exceptions. Cases are recorded in 
which it is claimed they appeared in the act of swallowing, 
but this seems incredible; others, in which they were ex- 
hibited in eight, ten, and fifteen minutes after. On the 
other hand, numerous instances are recorded where the 
time was protracted for many hours. A case has been 
reported in which the symptoms were delayed for sixteen 
hours after a dose of a drachm of the poison. These dis- 
crepancies may, in part, be accounted for by the stomach 
being empty or full at ttie time of administration ; also by 
the form of the dose, whether Hquid or solid; by the time 
of day, whether before going to sleep, or otherwise. The 



ARSENIC FATAL PERIOD. 439 

simultaneous use of opium or alcohol would, no doubt, 
exercise a modifying influence over this poison. 

The external application of arsenic, either to the sound 
skin or still more to abraded or ulcerated surfaces, is often 
followed by fatal results. Proofs of this are exhibited in 
the effects of the applications of cancer cures to ulcerated 
breasts ; also in the use of arsenical solutions to the sore 
heads of children. In some of these instances absorbed 
arsenic has been detected after death in the viscera of the 
body. Arsenic has also proved fatal when injected into 
the rectum and vagina. 

In all of the above cases of the external application of 
this poison, its usual constitutional effects were produced, 
such as burning and constriction of the throat, thirst, vom- 
iting and purging, great depression, and the various nervous 
disturbances above described. 

Fatal Dose. — The minimum deadly dose cannot be accu- 
rately fixed. The usual statement that two grains may be 
fatal rests on insufficient evidence. Dr. Witthaus, in a 
thorough search of reported cases, was unable to" find evi- 
dence of a smaller fatal dose than thirty grains, but the 
minimum is likely to be below this. Probably ten grains 
would be fatal to most persons unless treatment was prompt 
and efficient. Recoveries have occurred after very large 
doses but usually the greater part has been expelled by 
early vomiting. 

Fatal Period. — The great majority of deaths occur within 
twenty-four hours, and of these the most within eight or 
ten hours. The shortest period is recorded by Taylor, of 
a youth, aged seventeen years, who died in twenty minutes 
from the effects of a large dose accidentally swallowed ; the 
symptoms were of a tetanic character. Other cases are 



440 TOXICOLOGY. 

reported where death occurred in two or three hours. On 
the other hand, life may be prolonged for weeks, months, or 
even years, the patient suffering greatly during the interval. 

Arsenic is not a strongly cumulative poison ; it is tempo- 
rarily deposited in the liver and other organs of the body, 
after absorption, but it is rapidly eliminated from the system 
by the urine, bile, and other secretions. Should the person 
survive for two or three weeks, no trace of the poison may 
be found after death, in consequence of its total elimination 
during the interim. The exact period at which arsenic is 
completely eliminated from the human system is not fixed ; 
but the analyst need hardly expect to discover it after six- 
teen days, although it has been detected in the urine of a 
man twenty-four days after swallowing a large dose, and 
who subsequently recovered. 

The rapidity with which it is absorbed and deposited in 
the tissues is very great. Taylor found it in the human 
liver four hours after it had been swallowed, though doubt- 
less it reaches this organ much sooner. He believes that 
the liver acquires its maximum of absorbed arsenic (about 
two grains) in fifteen hours, after which the quantity gradu- 
ally diminishes. 

The question of the elimination of arsenic from the 
human system may have an important bearing, as in a case 
in which a person who has been taking small doses of 
arsenic, medicinally, for a length of time, should suddenly 
die from gastro-enteritis, and a post-mortem examination 
should reveal the presence of absorbed arsenic in the organs. 
Here both the symptoms and the chemical analysis would 
strongly confirm the suspicion of arsenical poisoning, unless 
the fact of the medicinal administration of the drug could 
be satisfactorily established. 



ARSENIC POST-MORTEM APPEARANCES. 44 I 

Post-mortem Appearances. — The most decided evidences 
of the irritant character of the poison are exhibited by the 
stomach, the mucous lining of which is usually highly 
inflamed, sometimes presenting a uniform, deep-red color, 
at others showing patches of diffused dark redness. Arsenic 
seems to have a specific effect on the stomach, no matter by 
what avenue it is introduced into the system. Occasionally, 
the lining membrane is thickened and corrugated ; again, it 
is softened and readily separated. When the poison has 
been taken in substance, it is not unusual to find patches 
several inches in extent, consisting of tough, yellowish- 
white masses of arsenous oxid, mixed with lymph and 
mucus, firmly adherent to the membrane, and forming so 
many foci of intense inflammation. White spots of arsen- 
ous oxid are often found between the rugae, and when a 
long interval has occurred before the examination, yellow 
stains may be found, as the result of a decomposition into 
the yellow sulphid. 

Ulceration of the stomach is rare ; but Dr. Reese wit- 
nessed two instances. In one, death occurred in eight hours 
after swallowing the poison. In the other case the exami- 
nation was not made until four months after death ; here, the 
ulcer was a quarter of an inch in diameter, and was sur- 
rounded by a deep zone of dark, effused blood, and had 
penetrated down to the peritoneal coat of the stomach. 
Perforation has not been reported. 

The upper portion of the small intestines is very apt to be 
involved in the inflammation ; also the cecum and rectum. 
Other organs, as the lungs, brain, and bladder, are occasion- 
ally found congested ; but these offer no diagnostic points. 
The most remarkable fact connected with the post-mortem 
appearances is the occasional absence of all signs of inflam- 



442 TOXICOLOGY. 

mation, even in cases where there had been violent inflam- 
matory symptoms before death. 

When death occurs within a few hours no changes in the 
microscopic appearance of the tissues may be recognizable, 
but in prolonged cases infiltration and fatty degeneration are 
likely to occur, hence careful pathologic examinations should 
be made of the liver, kidneys and heart. 

An important circumstance is the antiseptic power of 
arsenic, which accounts for the remarkable preservation of 
the body for many months after death, whereby the detec- 
tion of the poison is possible for a long period after burial 
— in one case fourteen years after death. Of course, after 
such an interval most of the body would be decomposed ; 
but still enough remains for the purpose of identification. 
In such cases there is generally noticed an absence of the 
usual cadaveric odor, and also the presence of numerous 
yellow patches over the abdominal viscera, due to the pro- 
diiction of the yellow sulphid, by the action of hydrogen 
sulphid on the arsenous oxid. 

It should, however, be stated that arsenic does not uni- 
formly exert this preservative power on a dead body; in 
fact, in some cases it would seem that putrefaction has ad- 
vanced with increased rapidity. These instances, however, 
are exceptional ; but they should put the expert on his 
guard against too positive an assertion as to the presence 
of arsenic when a body exhibits an unusual degree of pres- 
ervation, since this may be due to other causes. 

Treatment. — Vomiting should be promoted, but only by 
the mildest means ; the stomach-pump may be employed, 
if on hand ; warm diluent drinks are useful ; after this, the 
free use of freshly prepared ferric hydroxid. This can be 
prepared extemporaneously by treating a solution of any 



ARSENIC ANALYTIC METHODS. 443 

red salt of iron with any alkali, alkaline carbonate, or mag- 
nesia. Ferric chlorid and ferric subsulphate are common 
compounds suitable for the purpose. The precipitate should 
be collected on a strainer, e. g., a piece of muslin or linen 
washed two or three times with water and administered 
freely, best in milk or other demulcent liquid. Afterward 
a dose of castor oil should be given. 

There are numerous attestations to the value of this anti- 
dote ; it acts by converting the poison into an insoluble 
compound. Freshly precipitated magnesium hydroxid is 
also recommended as an antidote. 

Ferrous hydroxid obtained by adding an alkali to a 
solution of ferrous sulphate (green vitriol or copperas) is 
not considered an antidote, but it may be promptly con- 
verted into ferric hydroxid by the addition of some hy- 
drogen dioxid. The change is indicated by the conversion 
of the green precipitate into a red one. 

Analytic Methods. — In applying the more delicate tests 
for arsenic, it must be borne in mind that the element is 
widely distributed. It occurs in minute amounts in many 
so-called pure chemicals, and all reagents used for its de- 
tection must be carefully tested before being used in toxi- 
cologic analysis. 

Sublimation Tests. — (i) A small quantity of the white 
powder placed on platinum foil and heated is entirely dissi- 
pated in white inodorous fumes; (2) slowly heated in a 
narrow glass tube, it sublimes, forming a white ring of 
octahedral crystals on the cool portion of the tube visible by 
a good magnifier. Calomel and corrosive sublimate will 
each form white rings under similar conditions ; the arsenic 
deposit is distinguished from these by being in octahedral 
crystals ; by the action of sodium hydroxid solution which 



444 TOXICOLOGY. 

dissolves it without color, while it gives a black precipitate 
with calomel, and a yellowish with corrosive sublimate ; (3) 
moistened with ammonium sulphid, and evaporating, it pro- 
duces the yellow sulphid ; (4) put into a reduction tube, 
along with some reducing agent, as charcoal, black flux, or 
six or eight times its volume of dried potassium ferrocyanid, 
and heated by the flame of a spirit-lamp, it is reduced, and 
the metal is volatilized, and collects on the cool part of the 
tube in the form of a brilliant steel-gray ring, or mirror. A 
distinct odor, recalling that of garlic, is produced in this 
form of the test. 

In order to effect the sublimation and reduction success- 
fully, the reduction tube should be small — about an eighth 
of an inch in diameter, and three inches long, and it should 
be clean and free from moisture. The reducing agent 
should be dry and thoroughly mixed with the arsenous 
oxid. After it is introduced the tube should be wiped out 
with a wad of cotton or a roll of filtering paper. The tube 
should first be gently warmed just above the contents, and 
then the lower portion fully heated in the flame. This 
precaution insures a better formed metallic ring. 

For the sublimation simply, the above process is to be 
pursued, with the omission of the reducing agent. 

The obtaining the metallic ring, or mirror, by the re- 
ducing process, may be regarded as positive proof of the 
presence of arsenic ; but in a medico-legal case this should be 
confirmed by further proofs : ( i ) the arsenic mirror is wholly 
soluble in sodium hypochlorite ; (2) it is soluble in hot 
nitric acid, and the solution, on evaporation, leaves a brick- 
red deposit when touched with silver nitrate solution, due 
to the formation of silver arsenite ; (3) if the closed end of 
the tube be broken off and heat applied to the sublimate, it 



ARSENIC LIQUID TESTS. 445 

will readily volatilize, and, combining with the oxygen of 
the air, will condense on the upper portion of the tube in a 
white ring of arsenous oxid ; (4) this latter may be dissolved 
in a few drops of warm water and subjected to the liquid 
tests. 

Liquid Tests. — These are ammonio-copper sulphate and 
ammonio-silver nitrate. They should be prepared only 
when required for use. The former is made by the cautious 
addition of ammonium hydroxid to a somewhat dilute solu- 
tion of copper sulphate, until the precipitate is barely redis- 
solved. When this reagent is added to a solution of arsenous 
oxid, it throws down light-green copper arsenite. This pre- 
cipitate is soluble in ammonium hydroxid and in free acids. 
If the arsenic is in very minute quantities, the characteristic 
color does not appear immediately, but is deposited on 
standing. 

The silver test is prepared by adding ammonium hydroxid 
to a strong solution of silver nitrate, until the precipitate is 
barely redissolved. When this is added to the arsenical 
solution, a canary-yellow precipitate of silver arsenite occurs, 
which is freely soluble in alkalies and acids. 

These liquid tests are available only in perfectly pure 
solutions of arsenous oxid ; they are inadmissible in the 
presence of organic matter, since various organic substances 
will produce similar colors. They may, however, be satis- 
factorily confirmed, (i) by heating either of the dried pre- 
cipitates (copper or silver arsenites), either alone or with a 
reducing agent, in a reduction tube ; the former experiment 
will yield a sublimate of octahedral crystals, the latter the 
metallic mirror. (2) If the solution of copper arsenite in 
ammonium hydroxid be poured over a crystal of silver 
nitrate, a film of yellow silver arsenite is immediately formed 
around it. 



44^ TOXICOLOGY. 

Hydrogen Sulphid Test. — This consists in passing washed 
hydrogen sulphid gas through the solution, slightly acidified 
by hydrochloric acid ; a clear yellow precipitate falls — arsen- 
ous sulphid, soluble in the alkalies and insoluble in acids. 
In very dilute solutions, the precipitate may not separate 
until the excess of the gas is driven off by heat. 

Fallacies. — Cadmium, tin, and selenium yield somewhat 
similar precipitates. Practically, the only one that need be 
considered is cadmium, which, however, is easily distin- 
guished, as follows : ( I ) The arsenous sulphid is soluble in 
ammonium hydroxid and insoluble in the acids ; with cad- 
mium sulphid it is precisely the reverse ; (2) when dried 
and sublimed with a reducing agent, the arsenous sulphid 
yields a metallic ring ; the cadmium a brown oxid. 

The arsenous sulphid may be proved by ( i ) obtaining the 
metallic ring by subliming with a reducing agent; (2) by 
boiling the sulphid in hydrochloric acid, along with a piece 
of bright copper foil ; a steel-gray deposit shows the pres- 
ence of arsenic; (3) by dissolving it in boiling nitric acid, 
cautiously evaporating to dryness, and adding a few drops 
of strong silver nitrate solution, a brick-red silver arsenate 
will be produced. 

Marsh's Test. — The principle here involved is that when 
arsenic comes in contact with nascent hydrogen, it com- 
bines with it to form hydrogen arsenid (arsin), a gas which 
possesses peculiar properties, by means of which the arsenic 
may be recognized with great certainty. The simplest 
method is to add to the materials for generating hydrogen 
(zinc, water, and sulphuric acid), in a wide-mouth flask, the 
suspected arsenical solution. The cork fitted to the mouth 
of the flask should have two perforations, through one of 
which a perpendicular, funnel-shaped glass tube passes down 



ARSENIC — MARSH S TEST. 447 

below the surface of the Hquid contents ; through the other 
aperture a tube, bent at right angles, is inserted, out of 
which the generated gas issues. A drying tube (containing 
fragments of fused calcium chlorid, or of pumice stone 
moistened with sulphuric acid) is fastened by one end to 
the exit-tube, and by the other extremity to a horizontal 
tube of hard German glass, about a foot long, which may 
be turned up at the furthest end, and made to terminate in 
a small point, for burning the gas in a jet as it escapes. 

In performing this experiment certain precautions are 
necessary. In the first place, the absolute purity of the 
zinc and sulphuric acid must be secured. The acid should 
be diluted with two or three times its volume of water 
before being added to the zinc mixture. Secondly, caution 
should be exercised to have the atmospheric air completely 
expelled from the apparatus before lighting the jet, other- 
wise the mixture of hydrogen and air will produce a violent 
explosion. The evolution of the hydrogen should be 
rather slow. After waiting the proper time, the jet may be 
lighted; it will burn, if pure, with a nearly colorless flam.e, 
though it is usually yellowish from the sodium of the glass 
point. The purity of the materials may now be tested by 
applying the flame of a large spirit-lamp or a Bunsen 
burner to the horizontal glass tube until it is red-hot; if no 
stain or deposit occurs just beyond the heated spot, the 
absence of arsenic is certain ; or if no deposit forms on a 
piece of white porcelain held over the burning jet, the same 
conclusion may be held. 

A small quantity of the suspected solution is now to be 
introduced through the upright tube; action immediately 
commences, producing hydrogen arsenid, which has the 
following characteristic properties : 



44^ TOXICOLOGY. 

As soon as the arsenic combines with the hydrogen, an 
immediate change occurs in the appearance of the flame, 
which increases in size and acquires a faint bluish color ; 
and unless the arsenic be in minute quantity it evolves 
white fumes and gives out a garlicky odor. If these fumes 
are received into a short, wide glass tube, they will con- 
dense into a white powder, sometimes crystalline, and may 
be identified as arsenous oxid. 

If the jet be made to impinge on a piece of glass or 
white porcelain, held horizontally and just within the 
flame, a deposit of pure arsenic, of a brilliant steel-gray, or 
brownish-gray color, occurs, which may be multiplied by 
changing the position of the porcelain. In order to procure 
the finest deposits the flame should be steady and not too 
large. Although these spots may vary somewhat in color, 
they are always brilliant and never sooty. 

These deposits may be identified (i) by their immediate 
solubility in sodium hypochlorite ; stains of antimony, which 
they most resemble, are not thus affected. (2) When 
touched by a drop of ammonium sulphid, they do not 
immediately disappear; antimony stains are instantly dis- 
solved. (3) Both stains are attacked by hot nitric acid, and 
on evaporation yield white residues ; if now touched with a 
drop of strong solution of silver nitrate, the arsenic spot 
assumes a brick-red color, while the antimony stain remains 
unaffected. 

On placing the flame of a large spirit-lamp or a Bunsen 
burner immediately below the horizontal tube (which should 
have been previously contracted in several places), a deposit 
of metallic arsenic forms just in advance of the flame, which 
should be held a little behind one of the contracted spaces ; 
the deposit continues to increase until it may completely 



MARSH S TEST. 449 

occupy the whole of the narrow space, and even advance 
beyond it. This constitutes the arsenical mirror. It may 
have the steel-gray, brilliant appearance already described, 
or even a coppery hue, and it is highly characteristic of the 
presence of arsenic. Several such mirrors may thus be ob- 
tained by moving the flame to different parts of the hori- 
zontal tube, provided there is a sufficient amount of the 
material present. The tube may afterward be broken across, 
so as to separate the mirrors, which may be retained for 
exhibition or for other tests. 

This mode of experimenting yields even more delicate 
results than the jet ; but unless the quantity of arsenic is 
extremely small, it will always be possible to obtain both 
results by Marsh's process. 

One fallacy only may interfere with this experiment — 
the presence of antimony, which in contact with hydrogen 
yields a gas very similar to hydrogen arsenid, and, like 
the latter, is decomposed by heat, yielding a metallic de- 
posit. They may be distinguished as follows : The anti- 
mony mirror is deposited just over the heated spot and not 
in advance of it; it has usually a darker appearance than 
the arsenical mirror ; the latter is more easily volatilized 
than the former and condenses higher up in the tube in 
octahedral crystals. The two deposits may also be tested 
by the different reagents mentioned above ; also by dry 
hydrogen sulphid, which produces, with the arsenical gas, 
a yellow deposit, and with the antimonial gas an orange-red. 

If the hydrogen arsenid be passed through a solution 
of silver nitrate, a black precipitate of metallic silver is 
formed, arsenous oxid remaining in the solution. The 
filtered solution will contain, also, free nitric acid and any 
excess of silver nitrate. On neutralizing with ammonium 

39 



450 TOXICOLOGY. 

hydroxid a yellow precipitate will fall — silver arsenite. The 
analyst should not rely on the mere production of the black 
color, since other gases beside hydrogen arsenid might cause 
this ; but he should continue the experiment as above de- 
scribed. 

Bloxams Method. — The principle of this is the same as 
that in Marsh's process — the action on nascent hydrogen; 
but an electric current is employed to decompose the water 
instead of zinc. It is a delicate and satisfactory modifica- 
tion ; but it should be remembered that the arsenic should 
be present in the form of arsenous oxid. 

Reinsch's Test. — This consists in producing a deposit of 
copper arsenid on bright copper foil. The suspected solu- 
tion, acidulated with about one sixth of its bulk of pure 
hydrochloric acid, is first brought to the boiling-point, and 
a piece of bright copper foil is introduced and the boiling 
continued. The presence of even a very minute quantity of 
arsenic is soon indicated by the tarnishing of the copper, 
which ultimately assumes a dark steel-gray or even black 
color. If the quantity of arsenic be large, the deposit is 
immediate and very dark ; it may even break off in scales ; if 
the amount is very small, the stain upon the copper will 
be fainter and merely of a violet or bluish tint. Moreover 
the deposit on the copper is afi^ected by the degree of dilu- 
tion ; hence, if the quantity of the water be large, it should 
be reduced by evaporation, as it may require boiling for half 
an hour before a visible deposit occurs. 

This reaction is very delicate and extremely satisfactory, 
and commends itself by its simplicity. One great advantage 
that it possesses over the other tests is that it may be prac- 
ticed in complex organic fluids ; hence, it is often employed 
as a trial test. 



ARSENIC — REINSCH S TEST. 45 I 

Certain precautions are, however, required in employing 
it. First, the purity of the hydrochloric acid must be in- 
sured ; this is easily accomplished by first boiling some of 
the acid diluted with water and then introducing a slip of 
the copper. If no stain appears upon the latter after a few 
minutes, we may be certain of the absence of arsenic or 
antimony. Secondly, the copper must be both bright and 
pure. Its brightness is effected by rubbing it with emery 
paper, and it may be regarded as pure if, when boiled in 
the acid arsenical liquid, it is not dissolved and does not 
impart a green color to the liquid. Copper and pure hydro- 
chloric acid adapted to use in these tests can now be easily 
obtained from dealers. 

In applying this test it is best to use small pieces of 
copper successively, removing each fragment as it becomes 
coated. By this means the whole of the arsenic may be 
removed from the solution. One grain of arsenous oxid 
dissolved in the acid solution and treated by Reinsch's 
process will impart a distinct, dark, steel-gray coating to at 
least four hundred square inches of copper surface. This 
method will, therefore, serve for an approximate quanti- 
tative estimate of the poison. When it is in the form of 
arsenic acid, the solution is required to be much stronger 
for this test. 

Another caution to be observed is not to remove the 
copper too soon from the liquid, in case no deposit occurs ; 
in doubtful cases, the boiling should be continued for at 
least five minutes. If the copper be kept in for an hour or 
longer it may acquire a dark film, especially in the presence 
of organic matter, even in the absence of arsenic. 

Fallacies. — Other substances — antimony, mercury, silver, 
bismuth, tin, gold, platinum, and palladium ; likewise organic 



452 TOXICOLOGY. 

matter, especially if it contain sulphur — will impart a dark 
coating to copper in Reinsch's process ; hence, corrobora- 
tive proof is required. This is afforded by washing a frag- 
ment or two of the coated copper in distilled water, and 
then thoroughly drying them between the folds of filtering 
paper (avoiding touching with soiled fingers), and rolling 
them up into small coils, and then introducing one or more 
of them into a small, clean reduction tube, and applying the 
heat of a spirit-lamp. The arsenic will volatilize and con- 
dense in the cool part of the tube, in a white ring of octa- 
hedral crystals. The only other metals which could vola- 
tilize under such circumstances are antimony and mercury ; 
but the sublimate from antimony is either amorphous, or 
else in fine, acicular crystals, while the mercurial deposit 
consists of fine, spherical globules of the metal, easily recog- 
nized by a magnifier. 

The toxicologist must not overlook the fact that if copper 
is boiled for some time in an acid solution of complex 
organic matters, especially containing sulphur, it will be- 
come coated with a marked dark stain, and will, moreover, 
yield, when heated in a reduction tube, an amorphous sub- 
limate, which may even sometimes show acicular crystals, 
consisting apparently of a compound of copper. This sub- 
limate deposits very near the copper, and will not re-sub- 
limate. Hence, it follows that, for the complete corrobora- 
tion of Reinsch's test for arsenic, nothing short of the pro- 
duction of the octahedral crystals and their subsequent 
identification will suffice. Wormley has observed that an 
antimonial deposit from the copper may occasionally con- 
tain octahedral crystals, which are found lower down in 
the deposit. 

It must also be remembered that the presence of certain 



ARSENIC — STOMACH AND CONTENTS. 453 

substances in the arsenical solution may prevent the deposit 
of this metal upon the copper — viz., a chlorate or other 
oxidizing agents. Consequently, Reinsch's test is not ap- 
plicable to a solution obtained by boiling viscera in hydro- 
chloric acid and potassium chlorate. 

Bettendorf's Test. — A saturated solution of stannous 
chlorid in concentrated hydrochloric acid produces with 
arsenical compounds a brownish or grayish precipitate of 
free arsenic. The introduction of a small piece of tin foil is 
an advantage in some cases, but this must not be done when 
bismuth, antimony, or other easily reducible substance is 
present. The application of a moderate heat is advisable. 

Toxicologic Examination. — The analyst should always 
first search for particles of solid arsenous oxid in the stomach 
and the vomited matter, and carefully remove these for 
examination. Organic mixtures should be diluted, if neces- 
sary, with distilled water, and acidified with about one sixth 
part of hydrochloric acid, and boiled gently for about fif- 
teen minutes ; when cooled, the mixture should be strained 
and concentrated by evaporation over a water-bath. A 
portion may now be subjected to a trial test by Reinsch's 
process ; if no deposit takes place after boiling for half an 
hour, it is safe to conclude that no arsenic is present. If 
deemed advisable, another portion of the filtrate may be 
subjected to the action of hydrogen sulphid. It is not 
yet fitted for Marsh's process, owing to the large amount 
of organic matter present, which causes much frothing. 

Stomach and Contents. — The organ should first be care- 
fully examined as to its pathologic condition, and also for 
the presence of solid particles of the poison. It should 
then be cut up into small fragments with scissors known to 



454 TOXICOLOGY. 

be perfectly clean, and, together with its contents, placed 
in a clean porcelain evaporating dish ; distilled water added 
in sufficient quantity, together with about one sixth the 
bulk of pure hydrochloric acid, and heated gently for about 
an hour, when most of the solid portions will have become 
disintegrated. After cooling, the mixture is thrown upon 
a muslin strainer and the solid matters washed several 
times with pure warm water and squeezed. The strainer 
and contents should be preserved for subsequent examina- 
tion. The filtrate should be concentrated by evapora- 
tion over a water-bath and then filtered through paper. 

Reinsch's process may now be applied as a trial test to 
a portion of the liquid. If no result is afforded after a 
sufficient boiling, another portion may be tried by hydrogen 
sulphid; and if these give negative results, the absence of 
arsenic may be regarded as established. Marsh's process 
is inadmissible here for the reason just stated. 

If the presence of the poison is revealed by the trial test, 
a given portion of the liquid may be completely exhausted 
by Reinsch's process and the balance treated with hydrogen 
sulphid for several hours, until all the arsenic is precipitated. 
This process is facilitated by gently warming the liquid. 
The resulting precipitate will have a dirty yellowish color, 
— not the bright yellow seen when the arsenous oxid is pure, 
— and will contain both organic matter and reduced sulphur 
in greater or less amounts. 

The mere production of such a precipitate is not suffi- 
cient of itself to establish the presence of arsenic, since it 
is known that in an acid, complex, organic solution, asso- 
ciated with coloring matter, hydrogen sulphid will throw 
down a precipitate very much resembling an impure arsen- 
ous or antimony sulphid, but consisting only of organic 



ARSENIC — STOMACH AND CONTENTS. 455 

matter and free sulphur ; hence, a further examination is 
required to verify this suspected sulphid. 

The precipitate should be washed carefully on a filter 
and digested with pure ammonium hydroxid, which will 
dissolve out all the arsenous sulphid together with some 
organic matter. The solution is filtered and carefully 
evaporated to dryness. If much arsenous sulphid is pres- 
ent it will have a decided yellow color. When perfectly 
dried it should be verified by the methods described above. 
If, however, only a minute quantity be present, the dried 
residue will have a brown color and must be purified as 
follows : It is placed in a porcelain capsule, a little concen- 
trated nitric acid added, and the mixture evaporated to 
dryness over a water-bath, the addition of acid being re- 
peated until the moist residue has a yellow color. It is 
next moistened with a few drops of solution of sodium 
hydroxid, together with a little pure sodium carbonate and 
sodium nitrate, well stirred, and cautiously evaporated to 
dryness. The heat is now gradually increased until the 
mass becomes colorless, when the organic matter may be 
considered completely destroyed. The cooled mass con- 
sists of a mixture of the sodium arsenate with sodium 
nitrate and nitrite. It should be dissolved in warm water, 
and after filtration should be acidulated with pure sulphuric 
acid and evaporated till dense white fumes appear. By 
this treatment the residue is reduced to a mixture of the 
sodium arsenate and sodium sulphate. A portion of this 
solution may now be tested in a Marsh apparatus ; another 
given portion by hydrogen sulphid for quantitative deter- 
mination, the arsenic acid being first reduced to arsenous 
by sulphurous acid or sodium sulphite. 



456 TOXICOLOGY. 

Separation of Absorbed Arsenic from the Tissues. — 

It is indispensable in such investigations to examine for 
absorbed arsenic in the different viscera, as the hver, kid- 
neys, spleen, etc., inasmuch as its detection in the organs 
is evidence that the poison had been actually taken during 
life, provided always that post-mortem imbibition can be 
excluded. Besides, it may happen that, if the quantity 
swallowed has been only just sufficient to have caused 
death, the whole of it may have disappeared from the 
stomach by absorption and can only be discovered in the 
organs. The brain should likewise always be examined. 

Several methods are described for this sort of research, 
all having reference to one common end — the destruction 
of organic matters. Very often satisfactory results can be 
obtained by simply boiling the finely divided tissue in water 
and hydrochloric acid and applying Reinsch's test. 

Method of Fresenius and Babo. — The solid matters 
(as about one fourth of the liver) should be finely divided, 
pressed in a mortar, and pure water added to bring it to 
the consistence of thin gruel. The whole should then be 
digested in a porcelain dish over a water-bath with pure 
hydrochloric acid about equal in weight to the dry material. 
Small quantities of powdered potassium chlorate are from 
time to time added to the hot liquid, when effervescence 
will occur with escape of chlorin gas. In a short time the 
solid matters will disappear and the liquid will acquire a 
clear yellow color. The heat should be continued until 
all odor of chlorin has disappeared. When the liquid has 
cooled it should be properly strained. Any arsenic present 
will now exist in the form of arsenic acid. 

A portion of this liquid may be tested in a Marsh appa- 



ARSENIC — METHOD OF GAUTIER. 457 

ratus. But for the other tests it is necessary that the arsenic 
acid should be reduced to the lower oxid — arsenous. This 
is effected by adding sodium sulphite to the solution and 
heating it until all odor of sulphurous acid has disappeared. 
It is now allowed to stand for several hours and any deposit 
removed by filtration. The resulting solution, after proper 
evaporation over a warm bath, may be examined by hydro- 
gen sulphid, but not by Reinsch's process, for the reason 
above given. 

Method of Danger and Flandin. — The organs, prop- 
erly divided, are introduced into a glass retort, together 
with one fourth their weight of strong sulphuric acid, and 
heated on a sand-bath until the whole is thoroughly car- 
bonized and dried. After cooling, the mass is removed and 
powdered. The powder is moistened in a porcelain capsule, 
with one tenth of its weight of pure nitric acid, and heated 
on a water-bath for half an hour. This converts the arsenic 
into arsenic acid. Warm distilled water is now added and 
the matters filtered through paper. The filtrate is color- 
less, if pure ; if colored, it must be evaporated to dryness, 
treated again with nitric acid and water, and filtered the sec- 
ond time. The acid liquid must next be evaporated to dry- 
ness, to get rid of the nitrous vapors. It should now be 
mixed with a sufficient quantity of water, when it will be fit 
for testing, as above described. 

Method of Gautier consists of moderately heating the 
tissue or organs, finely divided, with about one third its 
weight of pure nitric acid, on a porcelain dish. Now lique- 
faction ensues ; pure sulphuric acid is now added (about 
one sixth part of the nitric acid), when violent action en- 
sues, and the mass assumes a brownish color. It is then 
40 



458 TOXICOLOGY. 

heated till vapors of sulphuric acid appear. The whole is 
next treated with small portions of nitric acid, successively 
added, which causes the mass to liquefy, with the escape of 
nitrous fumes. It is next heated until it is carbonized. It 
is then pulverized, and exhausted with boiling water, and 
filtered. The solution containing arsenic acid is next treated 
with sodium sulphite, and precipitated with hydrogen 
sulphid. 

Distillation Process. — The tissue should first be thor- 
oughly dried over a water-bath, and then mixed with about 
its own weight of pure hydrochloric acid, and distilled in a 
retort over a sand-bath almost to dryness, the distillate 
being received into a small quantity of water properly re- 
frigerated. By this process the arsenic is separated as 
arsenous chlorid. It possesses the advantage of imme- 
diately separating the arsenic, in a tolerably pure state, from 
the tissues. The distillate may be subjected to all the 
usual tests. 

The urine can be examined by Reinsch's test, by first 
concentrating by evaporation ; or it may be evaporated to 
dryness, and then treated with hydrochloric acid and potas- 
sium chlorate, and examined in the usual way. 

Solutions of arsenical compounds often mixed with zinc 
chlorid are now used by undertakers as embalming fluid. 

Arsenic is estimated quantitatively as a sulphid; lOO 
grains of pure dried sulphid represent 80.48 of arsenous 
oxid. 

Fowler's Solution. — This preparation, much used in 
medicine, is made by dissolving arsenous oxid in potassium 
carbonate and tincture of lavender. It contains four grains 
of arsenous oxid to the fluid ounce. 



PREPARATIONS OF ARSENIC. 459 

Arsenic Acid. — A powerful poison, but not often em- 
ployed as such. It is tested as arsenous oxid ; with hydro- 
gen sulphid it yields a yellow precipitate after a con- 
siderable time. The most delicate test is silver nitrate, 
which yields a brownish-red precipitate (silver arsenate). 

Silliman has given an account of the death of a boy, be- 
tween three and four years of age, from sodium arsenate, a 
poisonous preparation sold in New York under the name 
of '' pest poison," for destroying potato bugs. The most 
singular circumstance connected with the case was the entire 
absence of all the usual symptoms of arsenic poisoning, 
such as pain, vomiting and purging, etc., but, on the con- 
trary, those of a powerful narcotic, like belladonna or stra- 
monium. There were profound stupor, dilatation of the 
pupils, a rapid pulse, and hurried respiration. After partial 
recovery a relapse took place, the child dying, apparently 
from asphyxia, about nine hours after swallowing the 
poison. 

Copper Arsenite. — Scheele's Green. — A fine green pow- 
der insoluble in water, but soluble in acids and alkalies. By 
sublimation in a reduction-tube it yields crystals of arsenous 
oxid. 

Copper Aceto-arsenite. — Schweinfurth or Bninszvick 
Green. — Vienna or Emerald Green. — Paris Green. — A pig- 
ment sometimes used for staining wall paper, bon-bon paper, 
toys, articles of dress, artificial flowers, and millinery. 
Under the name of Paris green it has lately become the 
frequent cause of deaths, both homicidal and suicidal. It 
is readily identified by heating it in a test-tube, when it 
gives off fumes of acetic acid, deposits crystals of arsenous 
oxid, and leaves a residue of oxid of copper. 



460 TOXICOLOGY. 

Paper and other articles colored with this pigment may 
be easily tested by dipping them into a weak solution of 
ammonium hydroxid, when they will be speedily bleached, 
while the solution will become blue. If now a crystal of 
silver nitrate be placed in the latter, a film of yellow is im- 
mediately formed around it — silver arsenite. A drop of 
ammonium hydroxid applied to paper colored by this pig- 
ment immediately turns it blue. 

Chronic arsenical poisoning is occasionally produced by 
wall-paper colored with arsenical colors ; the fine powder or 
dust detached from the paper is inhaled into the lungs, and 
produces the symptoms above described. 

Sulphids. — Two sulphids are found as minerals, the 
yellow arsenous sulphid (orpiment), and the red arsenous 
disulphid (realgar). Arsenous sulphid is sometimes taken 
as a poison. They are both soluble in alkalies, and when 
mixed with a strong reducing agent and sublimed, they 
yield metallic mirrors. 

Hydrogen Arsenid. — This is a gaseous body of highly 
poisonous character, which is readily produced by the 
action of nascent hydrogen or arsenical compounds. It is 
not infrequently found as an impurity in hydrogen obtained 
by the solution of zinc in sulphuric acid. Cases of poison- 
ing by it occur among chemists and among operators en- 
gaged in chemical industries. The principal symptoms are : 
headache, severe lumbar and abdominal pain, vomiting, 
thirst, suppression of urine, and bloody urine. The cases 
are usually fatal though often prolonged. No special anti- 
dote is known. 



ANTIMONY COM FOUNDS. 46] 



ANTIMONY COMPOUNDS. 



Tartar Emetic is the only preparation of Antimony of 
much medico-legal importance ; but the chlorid is occasion- 
ally a cause of poisoning. 

Tartar Emetic (tartariced antimony; stibiatcd tartar, 
antimony potassium tartrate). — This body is of rather pecu- 
liar composition. It is formed from tartaric acid by replac- 
ing one of the hydrogen atoms by potassium and another 
by antimony monoxid, a radicle. The proper name would 
be potassium antimonoxyl tartrate. It occurs in large, 
colorless crystals and as a white powder. The commercial 
salt sometimes contains traces of arsenic. Heated in a re- 
duction-tube it blackens, and is reduced to a mixture of 
carbon and antimony. Heated on charcoal, before the 
blowpipe, it is also reduced, yielding globules of antimony, 
along with a white incrustation of the oxid. It is soluble 
in three parts of boiling and fifteen of cold water ; its solu- 
tion slowly undergoes decomposition. It is insoluble in al- 
cohol. The taste is nauseous, metallic, and acrid. 

Symptoms. — A harsh, metallic taste is perceived on swal- 
lowing, soon followed by nausea, retching, violent and inces- 
sant vomiting, great thirst, constriction of the throat, burn- 
ing pain in the stomach and abdomen, and profuse purging 
of a watery character ; sometimes blood is found in the dis- 
charges both from the stomach and bowels ; severe cramps 
in the extremities, a very feeble, rapid pulse, profuse per- 
spiration, extreme prostration, with a disposition to syncope. 
The urine is generally increased in quantity, but is voided 
with pain ; at times there may be delirium and convulsions 
preceding death. In exceptional cases, there is an absence 
of vomiting and purging, the symptoms being those of ex- 



462 TOXICOLOGY. 

treme collapse, with a cold, clammy sweat, feeble respira- 
tion, irregular pulse, delirium, unconsciousness, and tetanic 
convulsions. 

An occasional symptom is noted if the patient survives 
three or four days ; a pustular eruption over the body, 
similar to that produced by the external application of the 
substance. 

In some instances it appears to exert a slightly corrosive 
impression, causing aphthous ulceration of the tongue and 
inside of the mouth. While acting as an irritant to the 
gastro-enteric mucous membrane, it undoubtedly exerts a 
depressant effect upon the heart. 

Fatal Dose. — This has not been precisely determined. 
In some cases, two or three grains have produced alarming 
and even fatal effects, whilst in others enormous doses, up 
to an ounce, have failed to destroy life. Large doses, by 
exciting speedy vomiting, generally relieve themselves. 
Probably twenty to forty grains may be regarded as the 
usual minimum fatal dose for an adult. 

Fatal Period. — From an hour up to several days. In an 
exceptional case related by Deutsch, a woman took by mis- 
take a scruple of tartar emetic, and died one year afterward 
from the irritant effects on the alimentary canal. 

Post-mortem Appearances. — The irritant effects of this 
poison are displayed upon the lining- membrane of the 
stomach and bowels, which is deeply reddened, softened, 
and covered with a blackish, thick, and viscid secretion, 
sometimes streaked with blood. The throat, esophagus, 
stomach, and bowels also exhibit aphthous-looking spots, 
or excoriations, and occasionally true pustules may be seen 
scattered throughout the intestinal tract. 

The liver is generally enlarged and softened, and seems 



ANTIMONY COMPOUNDS. 463 

to have undergone a fatty degeneration. It is stated that 
the natives of Brunswick feed their geese upon antimony 
oxid, for the purpose of fattening them by increasing the 
size of their Hvers. The hings are often deeply congested, 
sometimes exhibiting a true apoplexy. The mucous lining 
of the windpipe and bronchi is uniformly reddened. The 
brain is generally congested, both in its membranes and 
substance, the latter presenting, when cut, numerous bloody 
points. The ventricles occasionally contain an excess of 
serum, and there may also be some submeningeal serous 
effusion. The heart exhibits nothing abnormal. Accord- 
ing to some authorities the blood retains its fluidity. 

Treatment. — Vomiting should be assisted by warm mu- 
cilaginous drinks, or the stomach-pump may be employed. 
The proper antidote is tannin, in the form of some astrin- 
gent vegetable infusion, such as green tea or nutgalls. 
Afterward opium and stimulants will be necessary. 

Chronic Poisoning. — This method of poisoning is believed 
to be somewhat frequent. The symptoms are a distressing 
nausea, with occasional vomiting, diarrhea with pasty stools, 
loss of appetite, emaciation, slimy tongue, feeble action of 
the heart, difficult breathing, a pale and anxious counte- 
nance, faintings with increased perspiration and urination. 

External Application. — When applied to the skin, tartar 
emetic occasions deep pustulation ; it is also readily ab- 
sorbed, especially from abraded surfaces, and produces all 
its constitutional effects the same as if swallowed, such as 
nausea, vomiting, debility, etc. Fatal effects have thus re- 
sulted, and the poison has been detected, after death, in 
the stomach, liver, kidneys, and other organs. 

Analytic Methods. — i. As a solid. — Touched with a drop 
of ammonium sulphid, or a solution of hydrogen sulphid, it 



464 TOXICOLOGY. 

immediately acquires an orange-red color ; this is character- 
istic of all the salts of antimony in their pure state. Heated 
in a reduction-tube, it blackens. 

2. In solution. — {a) A drop of a strong solution, evapo- 
rated on glass, will exhibit the tetrahedral crystals ; a weak 
solution gives a mass of confused crystals, {h) Either of 
the mineral acids dropped into it produces a white precipi- 
tate, soluble in an excess of the acid ; this precipitate is also 
soluble in tartaric acid, (c) Acidulated with hydrochloric 
acid, and boiled on bright copper foil, the latter acquires 
a violet-colored deposit of antimony (Reinsch's test). (J) 
The above solution imparts a black stain to a strip of pure 
tin foil in the cold, whereby it is distinguished from arsenic. 
{e) Hydrogen sulphid or ammonium sulphid throws down 
from a pure solution a characteristic orange-red precipitate 
of antimonous sulphid. This precipitate is soluble in sodium 
hydroxid, but scarcely so in ammonium hydroxid ; insoluble 
in dilute hydrochloric acid ; but if boiled in the concentrated 
acid, it is decomposed with the escape of hydrogen sulphid 
and the formation of antimonous chlorid. The resulting 
solution, if not too acid, when dropped into water imme- 
diately throws down a copious, white, flaky precipitate (the 
oxy chlorid, or powder of Algaroth), which is quite charac- 
teristic. This may be identified (i) by its solubility in 
tartaric acid; (2) by touching it with ammonium sulphid, 
which imparts to it an orange-red color. The white precipi- 
tate obtained by dropping the bismuth nitrate into water is 
not soluble in tartaric acid, and is blackened by ammonium 
sulphid. (/) Galvanic Test. — This is made by placing a 
few drops of the solution, acidified by hydrochloric acid, 
upon a platinum capsule, and touching the latter, through 
the liquid, with a strip of bright zinc; metallic antimony is 



ANTIMONY CHEMICAL ANALYSIS. 465 

deposited on the platinum at the point of contact as a brown- 
ish or black film. The liquid should then be poured off and 
the platinum washed in distilled water. A small quantity of 
ammonium sulphid, poured upon the stain, speedily dis- 
solves it (if antimony) by the aid of heat, and on evapo- 
ration an orange-red sulphid remains. A modification of 
this test may be advantageously applied for the detection 
of antimony in the organs. 

(h) Marsh's Test. — If a solution of antimony compound 
be subjected to the action of nascent hydrogen, hydrogen 
antimonid (stibin) is generated in precisely the same man- 
ner as is hydrogen arsenid under the same conditions. 

I. If the gas is burned at the jet, it gives a bluish flame, 
evolving white fumes of antimonous oxid, and if these fumes 
are received into a short, wide test-tube, held just above 
the flame, the white deposit of the oxid may be collected, 
which may be identified by ammonium sulphid. If a piece 
of cold, white porcelain be held horizontally just within 
the flame, the metal is deposited (as in the case of arsenic) 
in the form of a black, or nearly black, spot, which is 
usually surrounded by a grayish ring. These deposits may 
be multiplied by simply changing the position of the 
porcelain. 

The only fallacy to which this test is liable is from 
arsenic, which, as has been shown, behaves in a somewhat 
similar manner. But they can readily be distinguished from 
one another by a little attention. The antimony deposit is, 
as a rule, blacker and less brilliant than that of arsenic ; but 
if the spots of antimony are extremely small, this dis- 
tinction is not so observable. Again, the antimony stains 
are more slowly dissipated by heat than with arsenic ; the 
former immediately dissolve in a drop of ammonium sulphid, 



466 TOXICOLOGY. 

leaving on evaporation an orange-red deposit ; the latter 
(arsenic) are slowly affected by it, and leave on evaporation 
a yellov^ residue. Furthermore, the arsenic deposit is im- 
mediately soluble in a solution of sodium hypochlorite, 
which has little or no effect upon the antimony stain. 
Nitric acid will also serve to distinguish them ; both are 
dissolved by it, but on evaporation to dryness the arsenic 
residue gives to a solution of silver nitrate a brick-red color 
(silver arsenate), but the antimonial residue is not affected 
by it. 

2. If heat be applied to the horizontal tube in Marsh's 
apparatus, during the passage of the gas, decomposition 
takes place, as in the case of arsenic ; but the deposition of 
the antimonial mirror occurs immediately over and around 
the heated portion, and not in advance of it. If the quan- 
tity operated upon is very small, the deposit may take place 
wholly within the point of heat. These deposits exhibit 
the same chemical reactions as those produced on porcelain 
by the flame. 

3. If the hydrogen antimonid be passed into a solution 
of silver nitrate, the latter (as in the case of arsenic) be- 
comes black, the whole of the antimony is precipitated as 
silver antimonid (with hydrogen arsenid, the precipitate 
consists of silver, arsenous oxid being in solution). This 
black precipitate should be collected on a filter, washed and 
boiled with dilute hydrochloric acid, which dissolves out the 
antimony and leaves the silver. On filtering the solution 
and treating it with hydrogen sulphid, the characteristic 
orange-red sulphid is precipitated. 

Toxicologic Examination. — In certain cases it might be 
desirable to separate the tartar emetic, as such, from the 
stomach ; this may sometimes be accomplished by dialysis. 



ANTIMONY TOXICOLOGIC EXAMINATION. 467 

For all practical purposes it is deemed sufficient if the 
analyst can detect the antimony. The process of dialysis 
may also be employed to separate tartar emetic from food 
and vomited matters, but not, of course, for detecting 
absorbed antimony in the tissues. 

The stomach, properly divided, and contents should be 
acidulated with tartaric acid, and gently heated with suffi- 
cient distilled water over a water-bath for about half an 
hour. When cold, the matters should be strained through 
muslin ; the solid portions are to be washed and pressed, 
and the whole of the liquid carefully evaporated to about 
one half. Trial tests may now be made on a portion of this 
liquid (a) by inserting a piece of pure tin foil in the cold ; 
it will soon blacken if antimony is present; (b) acidulate 
with hydrochloric acid, boil and introduce a piece of bright 
copper foil (Reinsch's test) ; it will speedily acquire a violet 
stain, (c) The remainder of the liquid, slightly warmed, 
should be treated with hydrogen sulphid for several hours ; 
a dirty orange red or brown precipitate will be thrown 
down, consisting of antimonous sulphid, organic matter, and 
reduced sulphur. The mere production of a reddish-brown 
deposit under these circum.stances is not sufficient to estab- 
lish the presence of the antimony ; what has been said upon 
this point under the head of arsenic applies with equal force 
to antimony. 

The impure, dark-colored precipitate should be washed, 
treated on a porcelain capsule with a little pure nitric acid, 
and carefully evaporated to dryness ; the operation to be 
repeated until all the organic matter is destroyed. The 
residue is then moistened with potassium hydroxid heated 
moderately, and the mixture gradually fused. The cooled 
mass is stirred in a little water acidulated with tartaric acid, 



468 TOXICOLOGY. 

boiled and filtered. The solution should be colorless. This 
may then be employed for Marsh's method, or with hydro- 
gen sulphid; in the latter case the precipitate ought to 
exhibit the characteristic pure orange-red color. 

It may be remarked here that in every case of poisoning 
with antimony (as indeed with some other substances), the 
actual obtaining of the characteristic element as a specimen 
is usually insisted on as absolute and unequivocal proof; 
and this, too, in quantities sufficient to admit of its positive 
identification by all the recognized tests. This is not con- 
sidered a mere arbitrary or capricious rule. The highest 
authorities, such as Orfila, Tardieu, and Taylor, sanction it. 
Besides, the extraction of the antimony is not difficult, e. g., 
by tin foil, by galvanism, by Marsh's and Reinsch's proc- 
esses, and by the blowpipe. 

In the Organs and Tissues. — Most of the absorbed 
poison will be found in the liver and kidneys. A given 
portion of these organs, properly divided, should be boiled 
in water acidulated with about one sixth of hydrochloric 
acid. After proper concentration, trial tests may be made 
with a strip of tin foil in the cold, and copper foil in the 
boiling solution. If any indications of antimony are given, 
Reinsch's process may be carried out by subjecting a 
number of pieces of copper to the boiling acid liquid. 
These should be thoroughly washed and dried between 
the folds of bibulous paper ; then rolled up and intro- 
duced into glass reduction-tubes, and heated by the flame 
of a spirit-lamp ; a white sublimate will be deposited on 
the cool portion of the tube, as in the case of arsenic ; but 
it is either amorphous or else composed of very fine acicular 
crystals, 



ANTIMONY IN THE ORGANS AND TISSUES. 469 

The true nature of this antimony deposit is best shown, 
according to Watson, by boiHng the coated copper in a 
dilute sokition of potassium hydroxid, the metal being 
occasionally withdrawn from the liquid and exposed to the 
air to favor oxidation, when, after a time, the whole of the 
antimony will be in solution. The copper strip should now 
be removed, the solution acidulated with hydrochloric acid, 
and hydrogen sulphid passed through the liquid, when the 
antimonic sulphid, mixed with antimonous sulphid and 
sulphur, will be thrown down as an orange-red precipitate. 
The whole of the antimony may be thus removed by em- 
ploying successive strips of copper and subjecting them to 
the above treatment ; or the acidulated mixture may be 
boiled with potassium chlorate and subsequently treated as 
in the case of arsenic. 

The galvanic test may also be applied with great advan- 
tage to detect the presence of antimony in the tissues. 
Taylor's plan is an excellent one : Coil a portion of pure 
zinc foil around a piece of clean platinum foil, and suspend 
them in the acid solution of the tissues, sufficiently dilute 
to prevent too violent an action on the zinc. The liquid 
should be warmed. Sooner or later, according to the 
quantity present, the platinum will be coated with an ad- 
hering black powder of antimony ; or the solution, properly 
acidified, may be placed in a platinum dish and a zinc rod 
introduced ; after a sufficient time the antimony will be 
deposited on the platinum. Wash the platinum foil, and 
digest it in strong acid, which will dissolve off the 
antimony ; remove the platinum and evaporate to dryness. 
Redissolve the residue in hydrochloric acid, dilute the 
solution, and treat with hydrogen sulphid, which will pre- 
cipitate the pure sulphid ; or the deposit on the platinum 
may be dissolved off by ammonium sulphid. 



470 TOXICOLOGY. 

The absorbed antimony may be extracted by means of 
potassium chlorate and hydrochloric acid. In this case, 
in the subsequent application of hydrogen sulphid, there is 
no occasion to employ sulphurous acid to effect a reduction 
to a lower oxid, as in the case of arsenic. 

It has been ascertained that antimony may be eliminated 
through the glands of the stomach, even when introduced 
into the system by some other avenue — e. g., by hydrogen 
antimonid through the lungs. 

The iirine should always be examined in cases of sus- 
pected antimonial poisoning. This secretion is very soon 
affected by antimony compounds, and it may contain traces 
of them for some time after their discontinuance. The 
urine should be evaporated nearly to dryness, when it may 
be examined either by Reinsch's test, by tin foil, by the 
galvanic test, by Marsh's process, by potassium chlorate and 
hydrochloric acid with hydrogen sulphid, and by carboniz- 
ing with sulphuric acid. 

Antimonous Chlorid {Butter of Antimony). — This is a 
strong, corrosive poison, and has proved fatal in a number 
of instances. The symptoms and post-mortem lesions 
resemble those of the corrosive acids rather than those 
produced by tartar emetic. When thrown into water, the 
oxychlorid is generated, and falls as a copious, white, flaky 
precipitate. This is soluble in tartaric acid, and is instantly 
colored orange-red when touched with ammonium sulphid. 
The clear liquid contains hydrochloric acid, as shown by 
silver nitrate, which precipitates silver chlorid. 

Antimony is estimated quantitatively as an antimonous 
sulphid. Every loo grains of pure antimonous sulphid are 
equivalent to 85.75 ^^ the antimonous oxid or 192.19 of 
anhydrous tartar emetic. 



MERCURY COMPOUNDS. 47 



MERCURY COMPOUNDS. 



Mercury is not poisonous in the free state, unless very 
finely divided. It has been administered to relieve consti- 
pation. The vapor is poisonous, and as this may be given 
oft" even at ordinary temperatures, it happens that looking- 
glass platers and barometer and thermometer makers are 
very liable to become poisoned by the fumes. Cases of this 
form of poisoning have occurred among makers of vacuum 
electric lamps, for which a mercurial pump is employed. 
The symptoms of this sort of poisoning may come on 
gradually or suddenly; they may or may not be accom- 
panied with salivation. They are chiefly marked by the 
production of tremors of the limbs and paralysis, indicating 
the action of the metal on the nerve-centers. The general 
condition thus induced is named mercurial tremors and 
shaking palsy. The upper extremities are usually first 
affected, and then, by degrees, all the muscles of the body. 
There is an unsteadiness in the arms and legs, so that the 
patient cannot grasp an object, nor walk firmly on the 
ground. In bad cases he can neither speak nor chew his 
food. If the disorder be not checked, it proceeds to a fatal 
termination, attended with a loss of memory, insomnia and 
delirium. Another curious symptom, not generally recog- 
nized, but usually present, is a brittle state of the teeth, 
causing them to chip. 

The proper prophylactic treatment in this affection con- 
sists in cleanliness and good ventilation, together with the 
free internal use of albumin in the form of white of eggs. 

All the mercurial compounds are more or less poisonous, 
but the most important one is corrosive sublimate. 



4/2 TOXICOLOGY. 

Corrosive Sublimate (Mercuric Chlorid). — Occurs either 
in heavy crystalline masses of prismatic crystals, or as a 
white powder. It has a powerful styptic, nauseous taste, 
and is soluble in about thirteen parts of cold and three 
of boiling water. Alcohol and ether still more freely dis- 
solve it, and the latter has the power of abstracting it from 
its aqueous solution. 

Symptoms. — These usually come on immediately after 
taking the poison. A strong metallic, styptic taste is per- 
ceived, with a sense of heat and choking in the throat. A 
fierce, burning pain is felt, extending from the mouth to 
the stomach ; nausea, retching, and vomiting of stringy 
mucus, often tinged with blood ; pain in the abdomen, 
which is usually swollen and tender to the touch; severe 
purging, sometimes of bloody matters, accompanied with 
tenesmus, as in dysentery. The pulse is feeble, quick, and 
irregular; countenance flushed and swollen, though some- 
times it is pale and anxious ; the tongue is white and shriv- 
eled; skin cold and clammy; respiration difficult; intense 
thirst ; urine scanty or suppressed ; cramps of the extremi- 
ties ; stupor, fainting, convulsions, and death. Salivation is 
apt to appear on the second or third day, but it is not an 
invariable symptom in acute cases. In exceptional in- 
stances there has been an absence of abdominal pain, as also 
of vomiting and purging. 

Poisoning from corrosive sublimate differs from arsenical 
poisoning: (i) The former poison has a very distinct acrid 
taste, while the latter is almost tasteless. (2) The symp- 
toms of the former come on almost immediately after it is 
swallowed ; those produced by the latter are generally 
postponed from half an hour to an hour. (3) The dis- 
charges from corrosive sublimate poisoning are more fre- 
quently bloody than those from arsenic. 



CORROSIVE SUBLIMATE. 473 

The external application of corrosive sublimate has often 
been attended with fatal consequences, and both the symp- 
toms and post-mortem lesions in such cases resemble those 
produced by swallowing the poison, such as vomiting, purg- 
ing, suppression of urine, salivation, etc., injection of the 
stomach and kidneys, with ecchymoses throughout the 
intestines and bladder. Cases of this character, resulting 
fatally, are reported where a solution of corrosive sublimate 
was applied to the scalps of children, for the cure of porrigo 
and ringworm. The recent antiseptic use of the dilute 
solution, by the surgeon, has occasionally produced poison- 
ous results. 

Fatal Dose. — The minimum fatal dose for an adult may 
be considered to be three grains, although, as in the case of 
other mineral poisons, very large quantities have been taken 
with impunity, having been speedily vomited or promptly 
neutralized by proper antidotes. 

Fatal Period. — Taylor reports the shortest period on 
record, where death occurred in half an hour from an un- 
known quantity of the poison. In the majority of cases life 
is prolonged for several days — from one to five. In a sum- 
mary of cases given by Guy, about half the number died in 
less than twelve hours, and the remaining half in a period 
varying from three to eleven days. More than one half of 
the cases terminate fatally. 

Treatment. — Promote vomiting by the free use of warm 
diluent drinks. The proper antidote is albumin, as found 
in eggs. This decomposes the mercurial salt, forming an 
insoluble albuminate; a large excess of albumin will redis- 
solve the precipitate. The white of one ^gg is supposed to 
be capable of neutralizing four grains of corrosive sub- 
limate. In the absence of eggs, glutin or wheat flour, in the 
41 



474 TOXICOLOGY. 

form of paste, may be freely exhibited. Milk may also be 
freely used. 

Post-mortem Appearances. — These are generally confined, 
as in the case of arsenic, to the mucous membrane of the 
stomach and bowels ; but the corrosive action of the mer- 
curial is more marked. The stomach, together with the 
mouth, throat, and esophagus, is often softened, of a white 
or grayish color, and corroded. The intestines, especially 
the cecum, often exhibit similar appearances. Perforation 
of the stomach is rare. The kidneys and bladder are usually 
highly inflamed, the former especially congested about the 
Malpighian bodies, and the epithelial cells deformed, gran- 
ular, and partially destroyed. The bladder is empty and 
contracted. 

Byasson states that corrosive sublimate takes two hours 
to reach the urine, and four hours to reach the saliva. He 
never found it in the perspiration. He considers it to be 
completely eliminated in twenty-four hours after it has 
been taken. 

In chronic or slow mercurial poisoning the symptoms 
generally presented are loss of appetite, metallic taste in 
the mouth, fetid breath, soreness of the gums, increase of 
salivary secretion, pain in the stomach and abdomen, with 
diarrhea, quick pulse, hot skin, weakness, and emaciation. 
A bluish line has been noticed at the edge of the gums, as 
in lead poisoning. 

Salivation, although often absent in acute mercurial poi- 
soning, is nearly always observed in the chronic form. As 
this symptom accompanies the use of any other drugs, it 
cannot, of itself, be regarded as a proof of the administra- 
tion of mercury. In a doubtful case the matter may always 
be decided by a chemical examination of the saliva for mer- 



CHRONIC MERCURIAL POISONING. 475 

cury. Doubtless other mineral poisons are eliminated by 
this secretion, and their presence might be detected in it 
with proper attention. 

The relationship between salivation and mercurial poi- 
soning is a subject of considerable importance, since 
charges of malpractice have often been made against phy- 
sicians in cases of profuse and fatal salivation, accompanied 
by necrosis and gangrene, in which, in some instances, no 
mercury whatever had been administered, and in others 
where the dose has been exceedingly small. It is well 
known that there is no fixed, definite period when the saliva- 
tion comes on ; rarely before two days, often later. In a 
case reported by Wood, in which a teaspoonful of cor- 
rosive sublimate had been swallowed, salivation was profuse 
in the course of a few hours. It has been suggested that 
this very early flow of saliva was probably due rather to 
the local irritant action of the poison than to the result of 
absorption. 

An important fact not to be lost sight of in this relation 
is that salivation may be produced by various other agents 
besides mercurials, such as potassium iodid, iodin, the prep- 
arations of copper, lead, bismuth, arsenic, antimony, digi- 
talis, croton oil, cantharides, colchicum, and other drugs. 
A case has been mentioned to the author where a patient 
was profusely salivated by a single dose of five grains of 
potassium iodid. It is true that in the majority of the 
instances of non-mercurial salivation there is an absence of 
the usual mercurial fetor of the breath and the coppery 
taste, but it would appear from some recorded cases that 
these symptoms have been equally noticed in the salivation 
produced by arsenic and bismuth. 

Another point of consideration is the great difference in 



4/6 TOXICOLOGY. 

the susceptibility of persons to the mercurial impression. 
Thus it is almost impossible to salivate a very young, 
healthy child. Certain morbid conditions of the system, 
however, such as anemia and albuminuria, seem to predis- 
pose to its action. A dose of compound cathartic pills (con- 
taining only three grains of calomel) has been known to pro- 
duce very severe ptyalism. Christison states that three 
five-grain doses of blue pill, one every night, proved fatal ; 
and that two grains of calomel have caused ulceration of 
the throat, exfoliation of the jaw, and death. Such severe 
results are, however, quite infrequent. 

Mercurial salivation may be intermittent, ceasing for a 
time and reappearing without the further exhibition of the 
medicine during the interval. 

Furthermore, salivation may arise spontaneously from 
mechanical irritation of the mouth, or as the result of ex- 
hausting diseases, especially among the children of poverty 
and squalor, who are surrounded by bad hygienic influences. 
Among the last-named subjects, the two diseases, cancrum 
oris and gangrene of the mouth, are of frequent occur- 
rence. The symptoms of these conditions strongly resem- 
ble a very severe case of mercurial ptyalism, so that the 
diagnosis may be difficult. If, in such a case, the physician 
should have happened to have administered, at the beginning 
of the sickness, even a small dose of calomel, it might easily 
become a serious question to determine whether the death 
actually resulted from the mercury acting as a poison or 
from the disease ; and it would be no difficult matter to get 
up an action against the medical man for malpractice. 
Taylor cites a case in point. A charge was made against a 
medical practitioner for having caused the death of a child, 
aged four years, by administering an overdose of some mer- 



NON-MERCURIAL SALIVATION. 47/ 

curial preparation for the treatment of whooping-cough. 
On the fourth clay the child complained of soreness of the 
mouth ; the teeth became loose and fell out ; the tongue 
and cheek very much swollen, and the child died, in the 
course of a few days, from gangrene of the left cheek. The 
answer to the charge was that not a particle of mercury 
has been given — a fact clearly proved from the prescrip- 
tion-book of the medical attendant. This was evidently an 
instance in which gangrene from spontaneous causes had 
been mistaken for mercurial poisoning. As before observed, 
the chemical analysis of the saliva would settle any ques- 
tion of this kind. 

Analytic Methods. — (i) As a solid. — {a) A fragment 
heated on platinum foil is entirely dissipated in white, acrid 
fumes, which condense on a cool surface in white, radiating 
crystals, {b) Touched with a drop of sodium hydroxid solu- 
tion, it turns yellowish ; calomel, under similar circum- 
stances, becomes black, (c) A solution of potassium iodid 
imparts a bright scarlet color ; this is a very delicate test. A 
drop of this latter solution placed upon a piece of bright 
copper, in contact with the smallest fragment of corrosive 
sublimate, will produce a bright, silvery stain upon the 
copper, especially if it be rubbed with the finger ; this stain 
is immediately removed by heating it. {d) Ammonium 
sulphid at first turns it yellowish, but subsequently black. 
{e) Heated in a reduction tube with dried sodium carbonate 
it sublimes, forming a white ring on the cool part of the 
tube, which, under the microscope, is seen to consist of 
minute globules of metallic mercury. The white residue in 
the tube is shown to contain chlorin by dissolving it in 
water and applying silver nitrate. 

2. As a liquid. — (a) A drop evaporated on a glass slide 



47 S TOXICOLOGY. 

will yield large, needle-shaped, or prismatic crystals, (b) 
Solution of sodium hydroxid gives a yellow precipitate ; 
this, when dried and heated in a reduction-tube, will yield 
sublimate of mercury globules, with the evolution of oxygen 
gas. (c) Ammonium hydroxid produces a white precipi- 
tate, (d) Potassium iodid first causes a yellow, and imme- 
diately afterward, a bright scarlet precipitate, soluble in an 
excess of the reagent. When this is dried and heated, it 
volatilizes, and condenses in a yellow deposit, which grad- 
ually changes to scarlet, (e) Stannous chlorid first throws 
down a white precipitate (calomel), and, if in excess, a 
dark gray precipitate (metallic mercury), which runs into 
globules on being boiled. (/) Hydrogen sulphid and ammo- 
nium sulphid each causes a whitish precipitate, soon chang- 
ing to red, and ultimately to black. (^) A piece of bright 
copper put into a cold solution of corrosive sublimate, acidu- 
lated with hydrochloric acid, speedily acquires a silver-white 
coating of mercury. When the copper slip is dried and 
heated in a reduction-tube, a sublimate of globules is ob-" 
tained, easily identified by the microscope. This test is ex- 
tremely delicate, and will detect the To"io"o" of a grain, if 
the copper surface is very small and is heated in a very 
small tube. According to Wormley, a far smaller quantity 
— even the ^-q-oV o'o of a grain — may be identified by employ- 
ing a very small, thin, glass tube, the one tenth of an inch 
in diameter, and drawing it out, by heating, into a thin 
capillary neck. The small fragment of coated copper is 
introduced through the wider portion of the tube to the point 
of contraction, and the wider end is now carefully fused 
shut by the mouth blow-pipe, so as to give it the appear- 
ance of a small thermometer-tube, the bulb containing the 
coated copper. The tube is now heated at the bulb, and the 



CORROSIVE SUBLIMATE ANALYSIS. 479 

capillary end closed. On examination under the microscope, 
a well-defined ring of mercurial globules will be visible on 
the capillary-tube, just above the bulb. 

In case the mercurial sublimate in the reduction-tube 
should be dim and unsatisfactory, Tardieu recommends to 
introduce a minute crystal of iodin into the tube, pushing 
it down as far as the sublimate with a platinum wire. The 
open end of the tube is then stopped with wax, and it is 
kept in a horizontal position for about twelve hours, at a 
temperature of 30° or 40° C, when the deposit will assume 
a bright scarlet color, due to the production of mercuric 
iodid. After removing the iodin, the tube may be gently 
and progressively heated from below by the flame of a 
spirit-lamp, when the scarlet color will change to yellow ; 
on cooling the yellow mass, by gentle rubbing with a glass 
rod, will turn scarlet again, (h) Galvanic Test. — This con- 
sists in winding a strip of gold around a strip of zinc (or 
iron) and placing the coil in the acidulated solution. Guy 
recommends a simpler and equally certain method: To 
moisten a narrow strip of zinc with water, and to take up as 
much gold leaf as will adhere to it, and introduce this into 
the acid solution. The gold will, in a short time, become 
coated with a silver-colored deposit of mercury. It is then 
to be carefully washed and dried, and heated in a reduction- 
tube when the usual mercurial sublimate will be obtained. 
The gold test is generally regarded as the most delicate. 

Toxicologic Examination. — When the poison was admin- 
istered in the solid form, fragments of it may be found in 
the stomach yet undissolved ; these should be collected and 
identified. As corrosive sublimate is easily acted on by 
albumin, glutin, and other substances, much of it may be 
changed into insoluble compounds. If the dose taken be 



480 TOXICOLOGY. 

small and in the liquid form, it may escape discovery in the 
contents of the stomach. If the quantity in solution is con- 
siderable, it may be extracted by simply agitating it with 
twice its volume of ether, and, after it has settled, removing 
the ether by means of a pipette, and allowing it to evaporate 
spontaneously, when the salt will crystallize in white, silky 
prisms. These may be purified, if necessary, by dissolving 
in water or alcohol, and again crystallizing. This method 
has the advantage of recovering the poison in the exact state 
in which it was swallowed, without the reservation, however, 
that ether might act upon any mercurial salt in the presence 
of a chlorid — e. g., sodium chlorid — similarly. 

The stomach and its contents should be prepared in the 
usual manner, already described, and heated with distilled 
water and hydrochloric acid. After proper filtration and 
concentration, a trial test may be made with a strip of cop- 
per, allowing this to remain in the solution, if necessary, for 
several hours. The gold test may be applied in a similar 
manner. By either of these processes the metal can be 
recovered in a satisfactory manner. The other tests above 
mentioned may also be applied as corroborative proofs. 

The solid matters remaining, after straining off the fluid, 
will probably contain much of the poison combined with 
organic substances. These should be boiled in distilled 
water, with hydrochloric acid, until disintegrated, then 
filtered and concentrated, and tested as above. Another 
method is to dry the solid matters thoroughly, and digest 
them in warm nitro-hydrochloric acid, by which the insolu- 
ble mass is converted into soluble corrosive sublimate. The 
acid liquid is then evaporated to dryness, the residue dis- 
solved in water and filtered, and the usual tests applied ; or 
the corrosive sublimate is dissolved out by ether. 



TOXICOLOGICAL EXAMINATION FOR MERCURY. 48 1 

In the tissues. — The Hver, or other organs, should first 
be crushed in a mortar, with sufficient alcohol to render 
filtration easy. Acidulate the mass with hydrochloric acid, 
and gently warm for some time ; then filter through paper, 
and apply the copper, or the galvanic, test, and hydrogen 
sulphid to the filtrate. All the solid portions are now to be 
mixed with water and four parts of hydrochloric acid, and 
boiled for some time ; when cool, they are to be filtered and 
the filtrate examined as above. 

Should arsenic happen to be present in the tissues along 
with corrosive sublimate, on the application of Reinsch's 
test both metals will be precipitated on the copper, and 
both will sublime from the latter when it is heated in the 
reduction-tube; but in the cold, mercury alone will be 
deposited on the copper. 

To detect mercury in the saliva, acidulate about two 
drachms of this fluid with one fourth of hydrochloric acid, 
and introduce into the mixture a small piece of bright 
copper foil, and heat gently for several hours. The gold 
test may also be used. The silvery deposit will indicate the 
presence of mercury, which will be confirmed by heating it, 
when washed and dried, in a reduction-tube, and procuring 
the characteristic mercurial globules by sublimation. 

In examining the urine, evaporate about twelve or four- 
teen ounces down to one ounce ; acidulate this with hydro- 
chloric acid ; filter and boil the filtrate, and introduce a 
fragment of bright copper, and confirm as directed above. 

It should be remembered that death may ensue from 

corrosive sublimate and no mercury be found in the tissues, 

as where the person has survived for a number of days. 

Also, as in the case of other poisons, there may be a failure 

42 



482 TOXICOLOGY, 

to detect it in the stomach after death, even when large 
doses had been swallowed. 

On the other hand, the detection of minute quantities of 
mercury in the organs is not always evidence of poisoning, 
inasmuch as the person may have lately taken blue pill or 
calomel as a medicine; hence, caution should be exercised 
in reference to this point. 

Corrosive sublimate is usually estimated quantitatively 
as sulphid by carefully washing and drying the precipitate 
obtained by hydrogen sulphid. Every 100 grains of dry 
sulphid are equivalent to 116.8 grains of corrosive sub- 
limate. Sometimes stannous chlorid is used to precipitate 
mercury from solution. The globules should first be puri- 
fied by boiling them in a solution of sodium hydroxid, and 
afterward in hydrochloric acid. Every 100 grains of mer- 
cury represent 135.5 grains of corrosive sublimate. 

Mercuric lodid. — R. Brummitt reports the following case. 
A woman took some tablets of mercuric iodid containing in 
all about one fourth of a grain of the drug. She was soon 
seized with severe abdominal pain, and later fell uncon- 
scious to the floor. The physician found her lying flat on 
the face with extended arms and marked muscular rigidity, 
seeming, indeed, to be dead. The countenance was dusky, 
the eyes closed, conjunctiva insensitive, pupils dilated and 
the radial pulse imperceptible. A careful examination 
showed a cardiac movement and feeble respiration. A 
change of position was followed by improvement in res- 
piration and heart-action. There were no signs of corro- 
sion about the mouth or of vomiting. One tenth of a grain 
of apomorphin was given hypodermically, which caused 
vomiting of dark, partially-digested food. The stomach was 
washed out and white of tgg administered. In three hours 



POISONING BY LEAD. 483 

the patient was considered out of danger, but complained 
of soreness of the throat and some burning pain in the 
stomach. During the night there were numerous move- 
ments of the bowels. It may be that this patient was espe- 
cially susceptible to the poison. 

Other compounds of mercury may occasionally prove 
poisonous, as the mercuric oxid, mercuric nitrate, and mer- 
curic sulphate. The treatment, and analytic investigations 
in such cases are essentially the same as indicated above. 



LEAD COMPOUNDS. 

In the free state. Lead is not considered poisonous, ex- 
cept when freely divided, when it will be dissolved in the 
stomach. All its common compounds are poisonous, with, 
perhaps, the single exception of the sulphate, which is very 
insoluble. 

Acute poisoning by lead compounds is rare, except as 
the result of accident. On the other hand, chronic or slow 
lead-poisoning is of frequent occurrence, since there is no 
element more constantly and insidiously introduced into the 
human system than lead under its varied forms. In the 
arts, the workmen in this metal inhale the fumes and 
powders in smelting the ores and manufacturing white lead. 
Painters, plumbers, pewterers, and glazers of pottery are 
all exposed to similar danger. Sleeping in a freshly-painted 
room has been assigned as a cause of an attack of colic and 
paralysis, but these effects may have been due to emana- 
tions from the turpentine or benzin. 

The frequent handling of pewter vessels, and especially 
of new type, has produced lead palsy. The use of glazed 
pottery is another source of contamination, arising from the 



484 TOXICOLOGY. 

action of acids, such as vinegar, and of oils and fats ; also 
of alkalies on the glaze, which consists largely of litharge 
(lead monoxid). Even milk has become poisonous in this 
way. Cider and beer, drawn through leaden pipes, may 
become contaminated in the same manner. Wine may be- 
come affected by contact with the shot left in the bottles 
through carelessness. New rum is apt to contain lead, de- 
rived from the leaden worm of the still, while old rum is 
free from this adulteration. This is ascribed, with great 
probability, to the fact that old rum, being kept in oak 
casks, is deprived of its lead by the tannin of the cask. 

Certain medicinal substances often contain small amounts 
of lead, derived from the mode of their manufacture. Alka- 
line solutions, when kept in flint-glass bottles, soon become 
impregnated with lead. Commercial sulphuric acid almost 
invariably contains lead derived from the leaden vessels in 
which it is prepared. 

Many articles in domestic use are not infrequently con- 
taminated by lead, as flour (from the plugs of lead imbedded 
in the millstones), sugar, snuiT, tobacco, chocolate, and bon- 
bons — the latter articles from the impure tin-foil wrappers. 
Numerous cases of lead-poisoning have been traced to the 
use of chrome yellow (lead chromate), as a substitute for 
eggs in making buns and noodles. Canned goods often 
contain lead ; even when put up in glass cans lead may be 
dissolved from the rubber washers, containing lead carbon- 
ate, placed under the cover. 

The external application of the preparations of lead is 
often the cause of slow poisoning, as in handling the metal, 
already alluded to ; the use of hair-dyes and cosmetics ; 
and even from the glazed lining of hats. The direct appli- 
cation of white lead to the scalded surface, as a dressing, 
has been known to produce symptoms of lead colic. 



LEAD ACE:TATE ACUTE POISONING. 485 

Probably the most frequent source of chronic lead-poi- 
soning is through drinking-water which has, in some way 
or other, been in previous contact with metallic lead. The 
conditions under which this occurs are not fully understood. 
Rain-water, which is frequently preserved in cisterns for 
drinking purposes, should never be collected from a leaden 
roof, nor be conducted through leaden pipes, nor in any way 
come in contact with this metal. On the other hand, most 
river and spring water, which always contain more or less 
of saline ingredients, generally exert little deleterious in- 
fluence upon lead, in consequence of the action of some of 
the salts existing in the water ; these form an insoluble film 
or coating upon the surface of the lead, thus preserving it 
from any further action of the water. Free acids in the 
water very much increase the danger of contamination. 

Another cause of contamination may arise from a galvanic 
action between lead and other metals together, especially 
when in contact with water containing carbonic acid. 
Danger also arises from a leaden cover being over a pump 
or cistern. The vapor of the water (which is equivalent 
to distilled water), impinging on the metal surface, dis- 
solves off the oxid and carbonate, which may in time fall 
into and contaminate the water. 

The compounds of lead of toxicologic interest are the 
acetate, carbonate and chromate. 

Lead Acetate (Sugar of Lead) occurs in commerce in 
masses of white or light brownish crystals, somewhat re- 
sembling loaf sugar in appearance. It has an acetous odor, 
and a sweetish, astringent taste. It is soluble in water ; less 
so in alcohol. Its aqueous solution is often turbid from the 
presence of carbonate. 



486 TOXICOLOGY. 

It is not a very active poison. It is much used in med- 
ical practice, but its continued employment has occasionally 
resulted in bringing on symptoms of lead-poisoning. 

In doses of an ounce or two it acts as a powerful irritant, 
causing burning pains in the throat and stomach, and thirst, 
vomiting, twisting, colicky pains, with tenderness in the 
abdomen, obstinate constipation, retraction of the abdominal 
walls, anxious countenance, cold sweats, and convulsions. 
The urine is diminished in quantity. In protracted cases 
there is often paralysis of one or more of the extremities. 
Its influence on the nerve centers is marked by giddiness, 
stupor, convulsions, and coma. In some cases there is 
purging of bloody matters, though usually the fecal dis- 
charges are hard, dry, and black. The peculiar blue line 
upon the edge of the gums, characteristic of chronic lead- 
poisoning, may sometimes be observed in acute cases. 

The fatal quantity is uncertain ; an ounce has been swal- 
lowed with impunity, though a less quantity has occasioned 
alarming symptoms. The fatal period is equally uncertain, 
varying from a few hours to several days. 

The proper antidotes are soluble sulphates, especially mag- 
nesium sulphate, which forms insoluble lead sulphate. At 
first, however, vomiting should be promoted by zinc sul- 
phate ; afterward opium and castor oil may be required. The 
urine should be frequently examined for the presence of lead. 

Post-mortem Appearances. — Often no well-marked lesions 
discoverable. Sometimes there is inflammation of the 
alimentary tract. Sometimes the inner coat of the stomach 
and bowels is covered with a thick, whitish layer of mucus 
mixed with the poison, beneath which the membrane is 
reddened, or even abraded. The intestines are generally 
found contracted. 



POISONING BY LEAD LEAD PALSY. 48/ 

Chronic Po-isoning. — This may result from the continued 
internal use of any lead compound ; but it is more fre- 
quently produced among artisans working in white lead 
and litharge, or by the accidental introduction of the metal 
into the system through drinking-water or articles of food. 

The earlier symptoms are grouped under the names of 
Lead Colic, Painter's Colic, or Colica Pictonum; the latter 
symptoms are named Lead Palsy. 

Lead Colic. — The earlier symptoms are obstinate consti- 
pation and indigestion, with great depression. Then there 
is a feeling of twisting, grinding pain about the umbilicus, 
which may be rather relieved by pressure. The abdomen 
is hard and retracted ; sometimes there are scanty, hard 
evacuations, with much suffering. The urine is scanty and 
voided with difficulty. The countenance is dull and anx- 
ious ; skin cold and clammy ; pulse about natural ; respiration 
quick and catching; loss of appetite, with dryness of the 
mouth and throat; the breath is fetid, and there is often a 
metallic taste in the mouth. A characteristic sign of 
saturnine poisoning is the blue line at the margin of the 
gums, where they join the teeth, especially noticeable on 
the incisors. This is probably due to the deposition of lead 
sulphid in the capillaries of the gums, as can be shown by 
the microscope. Silver and mercury compounds occasion- 
ally produce a somewhat similar blue line, and it is wanting 
in some cases of chronic lead-poisoning. When once estab- 
lished, the condition is very persistent. 

Lead Palsy. — Lead colic, if allowed to continue un- 
checked, is very apt to terminate in paralysis, especially 
after repeated attacks of the former. Again, it may come 
on without any previous attack of colic. It usually affects 
the upper extremities. At first there is a dull, numb feel- 



488 TOXICOLOGY. 

ing in the skin of the fingers and forearms, trembhng of the 
arms and legs, unsteadiness of gait, loss of power in the 
hands and arms, which gradually waste away. The ex- 
tensors are more affected than the flexors, so that when 
the arm is raised the hand drops by its own weight, whence 
the common name of " wrist-drop " for this disease. If 
unchecked, brain symptoms present themselves, such as 
giddiness, torpor, and apoplexy ; sometimes there are epi- 
leptic fits, edema, albuminuria, and convulsions, ending in 
coma and death. 

Lead has been found, after death, in the brain, and espe- 
cially in the gray matter of the spinal cord; also in the 
bones, liver, and kidneys. Doubtless, many cases of ob- 
scure spinal, cerebral, and cardiac disease are really owing 
to chronic lead-poisoning — the element having been intro- 
duced unsuspectedly into the system. 

Sabrazes and Bourret made observations on the condi- 
tions of the blood in a case of attempted suicide with lead 
acetate solution in which a small amount of arsenic was 
present. They consider the quantity of arsenic too small to 
be taken into consideration. The greater part of the poison 
was thrown out by prompt vomiting; antidotes were also 
used. Nevertheless, symptoms of lead-poisoning developed, 
including discoloration of the gums, colic and headache. 
The blood showed normoblasts, basophilic, granular and 
polychromatic cells, also neutrophilic, polymorphonucleated 
leukocytes. These phenomena appeared on the second day, 
coincidently with the aggravation of the general symptoms, 
and declined as these declined, except that an intercurrent 
attack of measles increased the polymorphonucleated cells. 
The authors state that the use of arsenic does not give rise 
to such conditions. Blood examinations may, therefore, be 
of value in suspected cases of lead-poisoning. 



LEAD — TOXICOLOGIC EXAMINATION. 489 

Analytic Methods. — I. In the Solid State. — Lead acetate 
heated in a test-tube evolves an acetous odor, and fuses into 
a white mass ; if the heat is continued, it again fuses and 
slowly chars, and is converted into a reddish-brown mixture 
of the oxids of lead. Heated on charcoal, before the blow- 
pipe, it yields globules of lead, with a surrounding incrus- 
tation of yellow oxid. A fragment dropped into a solution 
of potassium iodid instantly turns yellow ; touched with 
ammonium sulphid, it immediately is blackened. 

II. In the Liquid State. — (i) A drop evaporated on glass 
yields opaque needles, which turn yellow when touched with 
a drop of potassium iodid solution or solution of potassium 
dichromate ; or black, by ammonium sulphid. (2) Dilute 
sulphuric acid causes a white precipitate, soluble in hot 
hydrochloric acid and in large excess of sodium hydroxid. 
(3) Potassium iodid gives a bright yellow precipitate, solu- 
ble in boiling water, which deposits it in brilliant yellow 
hexagonal scales on cooling. This crystalline form, which 
is seen under moderate magnifying power, is highly char- 
acteristic. (4) Potassium dichromate gives a bright yellow 
precipitate. (5) Hydrogen sulphid is a delicate test. The 
black sulphid is confirmed by heating it on charcoal, before 
the blowpipe ; or by dissolving it in nitric acid, by the aid of 
heat, evaporating to dryness, dissolving in water, and apply- 
ing the usual tests. (6) A drop or two of the solution, 
slightly acidified with acetic acid, is put into a platinum cap- 
sule, and a strip of zinc is made to touch the platinum 
through the liquid ; crystals of metallic lead are deposited 
on the zinc ; or a fragment of zinc may be placed in the lead 
solution in a watch glass, when very soon metallic lead will 
be deposited upon the zinc in an aborescent form. A salt 
of tin, under similar circumstances, would yield an abores- 



490 TOXICOLOGY. 

cent deposit of tin. Hence, the deposit must be further 
tested by dissolving it in nitric acid and applying the usual 
tests. 

Toxicologic Examination. — As lead acetate is easily pre- 
cipitated by many organic substances, such as albumin, 
casein, mucus, etc., the poison may exist both in the soluble 
and insoluble conditions. As a trial test, a good plan is to 
wet a piece of bibulous paper in the suspected solution and 
expose it to a jet of hydrogen sulphid gas, which will blacken 
it if it contains any lead. If the presence of the element 
be indicated, the mixture should be acidulated with pure 
nitric acid and boiled for some time ; when cold, it should 
be filtered, and the solids on the filter thoroughly washed 
and reserved for future examination. Concentrate the fil- 
trate by evaporation and treat with hydrogen sulphid ; allow 
the precipitate sulphid of lead to collect, pour off the super- 
natant water, boil in dilute nitric acid, add sufficient distilled 
water, and apply the usual tests. 

The solids on the filter should be dried and incinerated 
in a porcelain capsule ; dissolve the ash by heat in dilute 
nitric acid, filter, and treat with hydrogen sulphid, and prove 
the precipitated sulphid. 

If a sulphate has been given as antidote, a white pre- 
cipitate of lead sulphate may be found in the stomach. 
This should be collected and boiled with potassium hydroxid 
(previously tested to insure its freedom from lead) and the 
solution tested with hydrogen sulphid, or it may be boiled 
with ammonium carbonate, and the resulting lead carbonate 
decomposed by acetic acid. 

The solid organs (liver, spleen, etc.) may be examined 
either by boiling with nitric acid and water, evaporating to 
dryness, incinerating in a porcelain crucible, and again dis- 



LEAD TOXICOLOGIC EXAMINATION. 49 I 

solving by heat and dilute nitric acid ; or by directly incin- 
erating them in a porcelain crucible, and dissolving out the 
lead with strong nitric acid, evaporating to dryness, diluting 
with water, and precipitating with hydrogen sulphid. 

Since organic matters retain lead with great tenacity, the 
substances should not only be carbonized, but brought 
completely to an ash. Boucher has shown that the carbon 
retains lead residue, which resists, to a considerable extent, 
the action of solvents. This was verified in some examina- 
tions made by Drs. Reese and Leffmann, 

As regards the localization of lead in the different organs, 
this metal seems to be eliminated from the system largely 
through the liver and kidneys. That which is eliminated 
by the liver is found in the feces, which have lately been 
shown to contain a considerable proportion of the total lead 
eliminated. It is found in the brain and spinal cord, but in 
smaller quantities than in the above-mentioned organs. 

Since lead remains in the system for a considerable time, 
inquiry should always be instituted in case of the detection 
of only a minute quantity, in reference to the possibility of 
its accidental introduction into the system through the occu- 
pation, mode of living, etc., of the individual. 

The examination of the urine should never be neglected, 
since lead is eliminated from the system often through 
this secretion. From fifteen to twenty ounces of urine, 
acidulated with nitric acid, should be evaporated to dryness, 
incinerated as above directed, and the ash treated as already 
described. 

For the detection of lead in sweetmeats, slightly moisten 
them with water and put them on a plate, placing in the 
center a little capsule containing about a drachm of ammo- 
nium sulphid, and cover the whole with a tumbler. If lead 



492 TOXICOLOGY. 

be present the sweetmeats will, after a short time, be 
blackened by hydrogen sulphid evolved. 

Lead Chromate {Chrome Yellow). — Commercial chrome 
yellow often contains considerable lead carbonate and some 
lead hydroxid, which, being more soluble in the gastric juice, 
doubtless increase the activity of the drug. It has been 
much employed, not only as a pigment, but also exten- 
sively to impart a yellow color to confections and buns. 
In the latter case it is used as a cheap substitute for eggs, 
in order to give the desired rich yellow tint. Within the 
past few years a considerable number of cases of chronic 
lead-poisoning, from the use of buns colored with this salt, 
occurred in Philadelphia, many of which proved fatal. To 
the late Dr. David D. Stewart is due the credit of having de- 
tected this important fact. He diagnosed lead-poisoning in 
cases in which investigation had been made by other physi- 
cians without result, and, finally, after much inquiry, traced 
the source of poisonings to certain bakers. Most of the cases 
exhibited the usual marked symptoms of chronic lead-poison- 
ing, although some, especially the fatal ones, suffered from 
more pronounced eclamptic symptoms than is usual. Drs. 
Reese and Leffmann made a toxicologic examination of 
portions of the bodies of five of the fatal cases, at different 
periods after death, varying from one week up to two years. 
In every instance positive evidence of the presence of lead 
was afforded: in one body, in the spinal cord; in four 
bodies, in the liver ; in two cases, in the kidney ; in one 
case five months after death, in the brain. 

Chromium was not sought for in the above examinations. 

Lead is quantitatively determined as a sulphid. Every 
100 parts of dry sulphid represent 93.31 parts of the oxid, 
or 158.37 parts of crystallized acetate. 



POISONING BY COPPER. 493 

COPPER COMPOUNDS. 

Copper is not actively poisonous in its free state, but may 
dissolve in the stomach and produce marked symptoms. 
Copper coins swallowed may thus produce dangerous 
results. The inhalation of copper alloy in fine powder by 
artisans who work in so-called gold printing, causes serious 
results, such as constriction and heat of throat, vomiting, 
loss of appetite, and severe itching of the parts of the body 
covered with hair, which on examination, are found to be 
of a deep green color. 

Cases of accidental copper-poisoning can sometimes be 
traced to want of cleanliness in cooking, or to keeping food 
in copper vessels, particularly such food as contains a vege- 
table acid, vinegar, common salt, or any kind of oil or fat. 
So long as copper utensils are kept perfectly clean and 
bright, little risk is incurred in using them ; but if cleanli- 
ness be neglected, a poisonous deposit collects, which will 
contaminate any food with which it may come in contact. 
There is no risk in boiling articles of food or preserves in 
clean copper vessels, although it is unsafe to keep these 
articles, cold, in the same vessels ; in the latter case, the 
atmospheric air acts upon the metal at the point of contact 
of the contained substance. Dr. Falconer gives an instruc- 
tive example of this. A servant left some sauer-kraut, for 
only a couple of hours, in a copper pan which had lost its 
tinning. Her mistress and daughter, who ate of the cab- 
bage, died after twelve hours' sickness. Wildberg found 
the cabbage so strongly impregnated with copper that it 
was detected with metallic iron. There is risk in the use 
of copper boilers. In one case 3.5 grains to the gallon were 
found in water drawn from a kitchen boiler. 



494 TOXICOLOGY. 

The inference from the above facts would be that it is 
somewhat unsafe to employ copper vessels either for cook- 
ing, or, still more so, for preserving articles of food. Even 
tinned copper vessels are not always safe, because the tinning 
may consist of an alloy of tin and lead, and the latter might, 
in its turn, prove a source of danger. 

The alloy termed Dutch-metal, used for ornamenting 
cakes and confectionery as a substitute for gold leaf, may 
also prove a source of poisoning; likewise the blue and 
green papers used as wrappers for bon-bons, although the 
chief source of danger from the latter arises from the arsenic 
contained in their composition. 

The fine green color of many samples of pickles, peas, 
and preserved fruits is often due to the addition of a copper 
compound, as verdigris or blue vitriol. This may be easily 
detected by placing the suspected article in ammonium 
hydroxid, when, if copper be present, it will turn blue. 
Another method is to plunge a bright needle into the article ; 
if copper be present, it will speedily receive a reddish coat- 
ing of the metal. 

All copper salts are poisonous ; those of most importance 
are the sulphate (blue vitriol, blue stone), and the subacetate 
(verdigris). The arsenite and aceto-arsenite have already 
been described under the head of Arsenic. A copper car- 
bonate produced by the action of moist air on the metal, or 
on brass, is sometimes called verdigris. 

The salts of copper are rarely used for homicidal poison- 
ing, as they can be so readily recognized both by their, color 
and taste. Occasionally they have been taken suicidally, 
and more rarely by accident. The sulphate has been em- 
ployed for producing abortion. 

Symptoms. — The sulphate may be taken as a type of all 



POISONING BY COPPER. 495 

the salts. In large doses it speedily produces active vomit- 
ing, which usually expels much of the poison. There are 
pains in the stomach and bowels, great thirst, purging, 
headache, prostration, small, frequent pulse, with increased 
flow of saliva. The matters vomited are bluish or greenish ; 
those from the bowels are greenish, and tinged with blood. 
Sometimes there are severe cramps and convulsions. There 
is also suppression of urine, and, in fatal cases, paralysis and 
tetanus have preceded death. Jaundice is also an occa- 
sional result. Dr. Tidy speaks of it as " the specially diag- 
nostic symptom of copper-poisoning." It is not met with 
in poisoning by either arsenic or mercury compounds. 

The symptoms of slow poisoning (which is generally the 
result of the accidental introduction in articles of food) are 
an acrid, styptic, coppery taste, dry and parched tongue, eruc- 
tations with coppery taste, continual spitting, nausea and 
vomiting, colicky pains, diarrhea or bloody stools, with 
tenesmus, great thirst, heat of skin, small and tense pulse, 
scanty urine, headache, vertigo, faintness, cramps of the 
legs and convulsions ; occasionally jaundice and a blue line 
on the margin of the gums. 

Fatal Dose. — Not positively determined. Half an ounce 
of verdigris has proved fatal, and an ounce of the sulphate ; 
but larger quantities have been swallowed without produc- 
ing death. The usual emetic dose is five to fifteen grains. 
The usual fatal period is from four to twelve hours. 

Treatment. — Free vomiting should be assisted by the 
use of warm diluent drinks. The best antidote is albumin 
in the form of v/hite of eggs, as for corrosive sublimate. 
Milk is also very useful. 

Morbid Appearances. — These indicate the action of a 
powerful irritant to the mucous membrane of the alimen- 



496 TOXICOLOGY. 

tary canal, from the throat downward. The Hning mem- 
brane of the stomach is inflamed, softened, and sometimes 
ulcerated. It usually exhibits a bluish or greenish appear- 
ance, due to the color of the salt taken. The same is true, 
also, of the intestines. As a somewhat similar appearance 
may result from the appearance of bile, it is proper to dis- 
tinguish between them by the addition of ammonium hy- 
droxid,- which will impart a deep blue color if copper is 
present, but will cause no change in the green color if due 
to bile. Perforations have been found in the small intes- 
tines ; the rectum is occasionally ulcerated, and the lungs 
congested. 

Analytic Methods. — All the salts of common copper 
possess either a blue or green color. A few other salts are 
thus colored, as some of the cobalt salts, blue, and some of^ 
those of nickel, chromium, and uranium, green. When 
heated in the blowpipe flame they impart to it a beautiful 
green color ; and when heated on charcoal, with dry sodium 
carbonate, before the blowpipe, globules of copper are ob- 
tained. 

Copper Sulphate, blue vitriol, occurs in large crystals, 
soluble in water; the solution has a nauseous, styptic, 
metallic taste. The verdigris of commerce occurs in masses 
of a light green or bluish-green color. It is soluble in 
water and in dilute acids. 

1. Ammonium hydroxid produces a bluish precipitate 
which is redissolved by an excess of the precipitant, yield- 
ing a beautiful, clear, dark, purple-blue solution ; this color 
is immediately removed by an acid. The salts of cobalt, 
nickel, and chromium give somewhat similar results. 

2. Potassium ferrocyanid gives a reddish-brown precipi- 



COPPER SULPHATE. 4Q7 

tate, insoluble in excess of the reagent, but soluble in am- 
monium hydroxid. If the copper solution be very dilute, 
no precipitate may take place, but only the distinct brown- 
ish-red discoloration. 

3. Hydrogen sulphid, or ammonium sulphid, yields a 
brownish-black precipitate of copper sulphid. This should 
be corroborated by boiling in nitric acid, evaporating to 
dryness, dissolving in water, and applying the usual tests. 

4. A piece of bright iron immersed in a slightly acidu- 
lated solution of copper acquires a coating of copper. If 
the solution be very dilute, it should be concentrated by 
heat and a very small iron surface should be exposed ; a 
fine sewing-needle may be suspended in it for some hours. 
After it has received the copper coating, it may be removed 
and put into a porcelain capsule, with a little ammonium 
hydroxid, which, in a short time, will assume a blue color. 

5. The galvanic test consists in placing the copper solu- 
tion, slightly acidulated, in a platinum dish, and touching 
the latter, through the liquid, with a piece of zinc. The 
copper will be deposited on the platinum in the form of a 
reddish incrustation. The latter may be dissolved off the 
platinum by dilute nitric acid, evaporating to dryness, 
moistening it with water, and testing it as above directed. 

Toxicologic Examination. — A portion of the copper may 
be found in a soluble, and some in an insoluble, state. The 
liquid part has usually a bluish or greenish color. This 
should be filtered, concentrated by heat, and a trial test, by 
means of a bright sewing-needle, applied. Any reddish 
deposit on the latter should be examined, as above men- 
tioned. Sometimes the needle may acquire a reddish coat- 
ing simply from ferric oxid ; ammonium hydroxid will serve 
to distinguish them. If a large amount of copper should 
43 



49 S TOXICOLOGY. 

be indicated, hydrogen sulphid should be passed through it 
until all the copper is precipitated. This precipitate is to 
be treated after the manner above described. If the amount 
of copper be extremely small, the galvanic test is the most 
suitable. The filtered liquid, acidified with sulphuric acid, 
is placed in a platinum capsule, and fragments of pure zinc 
are put into it ; wherever there are points of contact between 
the two, there will be a reddish deposit on the platinum. 
This should be washed, and the copper dissolved off with a 
drop or two of dilute nitric acid. The nitric solution is to 
be evaporated to dryness, diluted with water, and tested as 
before described. 

If neither of the above tests reveals the presence of copper, 
it cannot be present in the liquid matters ; but the solids 
may possibly contain it. These should be boiled with dilute 
hydrochloric acid and water, filtered, concentrated by heat 
and tested. 

Traces of arsenic are sometimes found in the sulphate ; 
when the latter has been taken as an emetic, traces of this 
substance have been discovered in the matter vomited, and 
in the stomach (Taylor). 

In searching for the salts of copper in the stomach, this 
organ should be carefully examined for blue or green par- 
ticles. After treating the stomach and its contents in the 
usual manner, with the addition of water and hydrochloric 
acid, and filtering and concentrating by heat, the iron and 
galvanic tests may be used as trial tests. Hydrogen sulphid 
should then be passed through the liquid until all the copper 
sulphid is precipitated. This precipitate should be washed, 
boiled in dilute nitric acid, and evaporated to dryness ; if 
much organic matter is present, it should be moistened with 
strong nitric acid and heated until all the organic matter is 



rOISONTNG BY COPPER. 499 

destroyed. The dry residue is now dissolved in dilute nitric 
acid, and again evaporated to dryness, dissolved in water, 
and the usual tests applied. 

In the Organs. — These should be finely divided and 
thoroughly dried, and then incinerated in a porcelain cruci- 
ble, and the resulting ash treated with pure hydrochloric 
acid by heat, and then evaporated to dryness ; dissolve in 
water and apply the usual tests. Copper remains longer 
than arsenic in the tissues and organs ; as long as sixty days 
in the liver and lungs, according to Orfila. 

In the Urine. — Evaporate six to eight ounces to dryness ; 
treat the residue with the nitric acid and potassium chlorate, 
with the aid of heat, to complete incineration. Dissolve 
the resulting ash in hot dilute nitric acid, and evaporate to 
dryness. Dissolve the residue in warm water, and test as 
above. 

Copper is generally found in minute amounts in the 
human body, especially in the liver and brain. It is doubt- 
less introduced by articles of food. It is not known to be 
hurtful in these small quantities. It exists in minute pro- 
portions in certain vegetables, which, doubtless, obtain it 
from the soil. The discovery of faint traces of copper in 
the body after death is, therefore, no proof of copper poi- 
soning. 

Copper may be determined quantitatively as the free ele- 
ment, every loo parts of which are equivalent to 393.8 
parts of crystallized sulphate. 



500 TOXICOLOGY. 

ZINC, MAGNESIUM, BISMUTH, TIN, IRON, AND 
CHROMIUM COMPOUNDS. 

Cases of Zinc-poisoning are comparatively rare. In 
the free state zinc would soon be acted upon in the stomach, 
and converted into a chlorid, which might occasion serious 
results. The sulphate and chlorid are the preparations 
most likely to produce poisonous effects. 

The zinc of commerce (spelter) is apt to contain arsenic 
and other impurities. 

Zinc Sulphate ( White Vitriol) . — This is a white, crystal- 
line, soluble salt. It has an astringent taste ; effloresces on 
exposure to the air. It acts as a prompt, active emetic, 
without causing much depression of the system ; hence is 
indicated in cases of narcotic poisoning. It is used in small 
doses as a nerve tonic, and the system soon acquires a tol- 
erance of the medicine. 

Fatal Dose. — Half an ounce to an ounce. 

Symptoms. — A strong, metallic taste, attended with a 
burning sensation and constriction of the throat, nausea, 
violent vomiting, intense pain of stomach and bowels, purg- 
ing, small and frequent pulse, great anxiety, cold sweats, ex- 
treme prostration, dilated pupils, coma, and death. Experi- 
ments on animals show it to be a powerful heart depressant. 

Fatal Period. — A case is reported of a woman who 
swallowed, by mistake for Epsom salt, an ounce and a half 
of this salt, and death ensued in thirteen hours and a half. 

Post-mortem Appearances. — Decided evidences of inflam- 
mation are seen in the mucous membrane of the alimentary 
canal, such as redness, softening, ecchymoses, and some- 
times ulceration; a yellowish, pultaceous matter, covering 
the inner surface of the stomach and bowels ; congestion 



ZINC CriLORID. 501 

of the brain and membranes, also of the Kmgs, with bloody 
effusion into the pleura, and a distended, flabby heart. 

Zinc Chlorid. — In strong solution this is known as " Bur- 
nett's Disinfecting Fluid." It has been used as a disin- 
fectant and as a preservative for wood. It is a powerful 
corrosive, and has frequently caused death when taken by 
mistake or for suicide. 

The symptoms are in general the same as those pro- 
duced by the sulphate, only much more intense in their 
character, and resembling somew^hat those of the mineral 
acids. They come on immediately after swallowing ; the 
matters vomited and purged are frequently tinged with 
blood and mixed with shreds of mucous membrane ; froth 
may issue from the mouth, and a white appearance of the 
inside of this cavity has been noticed. There may also be 
loss of voice. 

Fatal Period. — Taylor records the most rapidly fatal case 
— for hours. On the other hand, the case may become 
chronic, lasting for years, and ending in stricture of the 
esophagus and exhaustion. 

Post-mortem Lesions. — In addition to the usual inflamma- 
tory signs those of a corrosive will be noticed, such as ero- 
sion or destruction of the coats of the stomach. Sometimes 
these are hard and leathery, thickened, and corrugated. The 
pylorus has been found constricted, and appearing as if 
cauterized. Constriction of the esophagus has also been 
noticed, together with a softened condition of its mucous 
membrane. The brain and lungs are congested ; the heart 
not affected, but usually distended. The blood is dark and 
uncoagulated. 

Treatment. — Assist the evacuation of the poison by the 
free use of mucilaginous drinks. The best antidote is albu- 



502 TOXICOLOGY. 

min, as In corrosive sublimate and copper-poisoning. Milk 
should be freely used. Opium should be given to combat 
the irritation. 

Analytic Methods. — In the solid state the sulphate may 
be distinguished from Epsom salt and oxalic acid (which it 
much resembles in appearance) by exposing a small frag- 
ment, mixed with sodium carbonate on a piece of charcoal, 
to the flame of the blowpipe ; it quickly fuses and the vapor 
forms an incrustation on the charcoal, which is first yellow, 
and becomes white on cooling. A solution of potassium 
dichromate applied to a crystal of zinc sulphate turns it 
yellow, which is not the case with Epsom salt. 

In Solution. — (i) The alkalies precipitate the white 
hydroxid, which is soluble in excess of the precipitant. 
(2) The alkaline carbonates throw down the white carbon- 
ate, insoluble in excess of the precipitant, but soluble in 
excess of ammonium carbonate. (3) Potassium ferro- 
cyanid gives a white precipitate. (4) Hydrogen sulphid 
throws down the white sulphid, soluble in hydrochloric 
acid. This should always be verified by dissolving it in 
hot hydrochloric acid, filtering, diluting, and subjecting it 
to the other tests. 

Toxicologic Examination. — In a case of suspected poison- 
ing it should always be remembered that zinc sulphate may 
have been administered as an emetic ; hence, although dis- 
covered in the body after death, it may not have been the 
actual cause of death. If found, other poisons should also 
be sought for. The organic matters, along with a little 
acetic acid, should be gently heated for some time in order 
to dissolve out the zinc that may have combined with albu- 
min, fibrin, etc. After cooling, the solution should be filtered 
and concentrated, and then treated with hydrogen sulphid. 



MAGNESIUM SULPHATE. 503 

The precipitated siilphid is collected on a filter, washed, and 
dissolved in strong nitric acid. The nitrate is evaporated 
to dryness, dissolved in water, and subjected to the usual 
tests. 

As the preparations of zinc usually contain iron, the 
presence of the latter metal will more or less modify the 
reactions of the former. The iron may be separated by an 
excess of ammonium hydroxid, which will precipitate the 
iron oxid, while it retains the zinc oxid in solution. 

The tissues (liver, kidney, spleen, etc.) may be examined 
either by boiling with dilute nitric acid, evaporating to dry- 
ness, and adding small quantities of nitric acid, and heating 
until all the organic matter is destroyed, or else by inciner- 
ating the perfectly dried viscera in a porcelain crucible, and 
treating the resulting ash with nitric acid; evaporating to 
dryness, and dissolving the residue in water ; acidulate with 
hydrochloric acid ; again evaporate to dryness ; dilute with 
water, and apply the usual tests. 

Zinc chlorid is frequently present in embalming solutions. 

Quantitative Estimate. — Zinc is usually determined as 
oxid. The boiling solution is precipitated with sodium 
carbonate. The precipitate is collected on a filter, washed 
and dried, and then ignited. Every lOO grains represent 
397.7 grains of crystallized sulphate, or 138.9 grains of 
zinc chlorid. 

Magnesium Sulphate. — Epsom Salt. — This household 
aperient is generally regarded as entirely safe, but the fol- 
lowing case, reported by Neale, shows the serious symptoms 
that a large dose may cause. A boy, 15 years old, took 
one ounce of the drug at a dose. Three evacuations oc- 
curred and in a few hours he became sick and vomited fre- 



504 TOXICOLOGY. 

quently. He did not receive medical attendance until the 
next day, when he was found in a position of flexion, except 
that he occasionally rolled on his stomach. He was 
apathetic, but conscious and was deeply cyanosed ; pressure 
on the skin caused white marks which remained for a long 
while, showing an extremely sluggish circulation. The 
conjunctiva was deeply injected, the pupils unequally di- 
lated. The covered parts of the body had a roseolous rash, 
and a zone of herpes zoster developed in the left submam- 
mary area. Tetanic spasms occurred occasionally in the 
right arm and on the right side of the face. Sordes existed 
on the tongue and teeth, the abdomen was distended and 
the urine was not retained. No radial pulse was perceptible 
on the right and only a feeble one on the left side. The 
heart's action was weak and could not be counted. The 
hands and feet were cold, although the axillary tempera- 
ture was 105° F. Under stimulant treatment he recovered 
rapidly and completely. An analysis of a portion of the 
salt remaining from that taken showed that it was pure 
magnesium sulphate. 

Two other cases of poisoning by this substance are noted 
in the report of the above case. Both resulted fatally. In 
one case, an adult took one ounce; in the other, a boy of 
ten years was killed by two ounces. 

Bismuth Sub nitrate (Bismuth Oxy nitrate — M agist ery of 
Bismuth — Pearl White). — This substance is considerably 
employed, both medicinally and as a cosmetic. As a 
medicine it is given in doses of five to thirty grains. Sev- 
eral fatal cases have been reported as resulting from large 
doses, the symptoms being those of a violent irritant poison. 
Many authorities ascribe these results to the adulteration 



ZINC — BISMUTH SUBNITRATE. 505 

of the bismuth with arsenic. Taylor states that this adul- 
teration is very common, and that he detected arsenic in 
comparatively large quantities in three out of five specimens 
obtained from London druggists. 

This impurity may essentially modify an opinion as to 
the presence of arsenic in a body when bismuth has been 
previously administered medicinally. A case occurred in 
which it was contended that the trace of arsenic alleged to 
have been discovered in the liver of the deceased, was to 
be ascribed to the bismuth subnitrate which had been taken 
before death. Some of the same material was found to be 
contaminated with arsenic. The prisoner was acquitted. 

Bismuth subnitrate is in the form of a white powder, in- 
soluble in water, but soluble in nitric acid. The solution 
thrown into water yields a copious white precipitate, which 
is blackened by ammonium sulphid, and is not soluble in 
tartaric acid. 

Dreesman reports a case in which after the use of an 
ointment containing ten per cent, of bismuth subnitrate, on 
an extensive burn, a black sediment appeared in the urine 
in the third week. Three weeks later a marked inflammation 
of the mouth occurred, with pain and difficulty in swallow- 
ing; the gums showed a blue-black tinge. The substitu- 
tion of a boric acid ointment was followed by immediate 
improvement. Analysis showed that the bismuth was free 
from other poisonous substances, especially lead. 

A delicate test for bismuth is a piece of paper wetted with 
a solution of potassium thiocyanate and dried; a yellow 
spot appears at the point of contact. It is stated that the 
urine will reveal the presence of bismuth, a few hours after 
taking the subnitrate, by means of this test. 
44 



5o6 TOXICOLOGY. 

Salts of Tin. — The only preparations of tin requiring 
notice are the chlorids. The effects of these salts upon the 
system are those of the metallic irritants; but the instances 
of poisoning by them are rare. 

Stannous chlorid, tin dichlorid, gives a brown precipitate 
with hydrogen sulphid. Corrosive sublimate throws down 
the mercury. Gold chlorid gives a fine purple precipitate 
— the purple of Cassius. A fragment of zinc precipitates 
metallic tin in an arborescent form. 

Stannic chlorid, tin tetrachloride is precipitated yellow by 
hydrogen sulphid. This sulphid is distinguished from 
arsenous sulphid by being insoluble in ammonium hydroxid, 
and from cadmium sulphid by being insoluble in hydro- 
chloric acid. Corrosive sublimate and gold chlorid yield 
no precipitate with it. 

The preparations of silver, gold and platinum (with 
some allied bodies) are all highly irritant and corrosive; 
but they so rarely are the occasion of poisoning in the 
human subject that they need no further discussion here. 

Iron Compounds. — Ferrous sulphate (green vitriol) is 
highly irritant in large doses, having proved fatal in several 
instances. Its action resembles that of copper sulphate, 
though less violent. 

Ferric chlorid in the form of tincture (muriated tincture 
of iron) is much used in medicine. In large doses it acts as 
a violent corrosive poison. Christison records the case of 
a man who swallowed, by mistake, an ounce and a half of 
the liquid, and who died in about five weeks. It is occa- 
sionally used as an abortive. 

Preparations of Chromium.^ — The salts of chromium 
most used in the arts are the potassium chromate, dichro- 



POISONING BY OXALIC ACID. 507 

mate, and lead chromate. The two former are violent irri- 
tants in large doses ; sometimes acting, also, as corrosives 
to the lining membrane of the alimentary canal. The latter 
has been noticed under Lead. 

Potassium dichromate may be distinguished — (i) by its 
deep orange-red color; (2) by solution of lead acetate, 
which precipitates the yellow lead chromate; (3) by silver 
nitrate, which throws down a deep red precipitate ; hydro- 
gen sulphid gives a dingy green sulphid. 

OXALIC ACID. 

Various oxalates, especially acid potassium oxalate and 
calcium oxalate, occur frequently in plants, e. g., rhubarb, 
wood-sorrel, dock, lichens, etc. Oxalic acid is extensively 
used in the arts, under misleading names. It is rarely 
employed for homicidal poisoning, since it would be easily 
detected by its sour taste ; but it is sometimes resorted to 
for suicidal purposes, and it has been frequently the cause 
of accidental death, from its being mistaken for magnesium 
sulphate (Epsom salt), which it resembles in appearance. 

Symptoms. — These depend very much on the size of the 
dose and the degree of concentration. In the quantity of 
half an ounce to an ounce, it acts as a prompt, violent, cor- 
rosive poison. In smaller doses and more diluted, its irri- 
tant effects may be much lessened or altogether lost; but 
its remote, specific operation on the heart and nerve-centers 
is very observable in the acute pain in the back, extending 
down the limbs, attended with tingling and numbness, and 
with tetanic spasms, together with occasional narcotism. 
On the heart it acts as a decided depressant. 

When swallowed in a very large dose, and dissolved in a 
small quantity of water, the effects are immediate. An 



508 TOXICOLOGY. 

intensely sour taste is followed by a burning sensation in 
the gullet, extending down to the stomach ; violent pain in 
the abdomen, increased by pressure ; constriction of the 
throat; vomiting of a greenish-brown or black matter, 
sometimes mixed with blood. If the patient lives, purging 
of a similar character sets in. The remaining symptoms 
are those of collapse, such as extreme debility, a cold, 
clammy skin, feeble, rapid pulse, and hurried respiration. 
There are also soreness of the mouth, swelling of the 
tongue, intense thirst, restlessness, and distressing cough; 
also, frequently, cramps, and numbness of the legs and 
arms, loss of voice, acute pain in the back and head, de- 
lirium and convulsions — symptoms that indicate the action 
of the poison on the nervous system. As in the case of 
other violent poisons, the above-mentioned symptoms are 
liable to many exceptions and anomalies ; thus, vomiting 
and pain may both be absent. 

Christison mentions a case in which leeches that had been 
applied to the epigastrium of a patient who had been poi- 
soned by this acid, fell off dead, showing evidently that it 
had passed into the circulation. In cases of poisoning the 
urine may contain crystals of calcium oxalate in abundance ; 
also, albumin and tube-casts, and, according to some writers, 
deposits of similar crystals are found within the tubules. 

Fatal Dose. — Half an ounce to an ounce is regarded as a 
fatal dose for an adult. Dr. Taylor quotes a case where 
one drachm of solid crystals proved fatal to a boy sixteen 
years old in eight hours. There are, however, cases on 
record where much larger doses have been swallowed with- 
out causing death. 

Fatal Period. — In a large, concentrated dose, oxalic acid 
is one of the most energetic poisons known. Christison calls 



OXALIC ACID POST-MORTEM APPEARANCES. 5O9 

it '* the most rapid and unerring of all the common poisons." 
Ogilvie reports the most rapidly fatal case known, where 
death occurred in three minutes after swallowing it. In 
other cases, death has followed in ten minutes ; the majority 
of cases prove fatal within one hour. Again, instances 
have occurred where the patient has survived for many 
hours, and even days. Beck alludes to the case of a woman 
who died from the secondary effects of the poison, after 
several months of suffering. 

Treatment. — This should be prompt, in order to be of any 
service. The best antidotes are chalk and magnesia, mixed 
up with milk. The alkalies and their carbonates are inad- 
missible, on account of their forming soluble poisonous 
compounds with the acid. Lime-water and oil are useful. 
Opium is indicated to relieve the severity of the symptoms. 

Post-mortem Appearances. — The lining membrane of the 
mouth, throat, and esophagus will usually be found white, 
shriveled, and easy of removal ; it may be covered over with 
the brown matters discharged from the stomach. The mu- 
cous membrane of the esophagus may be entirely separated, 
displaying a surface of a brown color, and raised in longi- 
tudinal folds. The stomach, which is frequently contracted, 
contains an intensely acid, brown, gelatinous fluid ; the 
mucous membrane, if death has been rapid, may appear 
soft and pale, often without marks of decided inflammation ; 
but if death has been delayed, it is usually black in some 
places, and in others intensely congested and in rugae, with 
portions peeling off, revealing a gangrenous condition of 
the subjacent tissue. Such cases resemble those of sul- 
phuric acid poisoning. Perforation of the stomach is rare. 

The intestines are usually highly congested, if death has 
been at all delayed. The lungs generally and the brain 



5 I O TOXICOLOGY. 

occasionally, have been found congested. The heart is 
sometimes quite empty, and at others distended with dark 
blood. The kidneys exhibit a peculiar white zone in their 
cortical parts, which the microscope shows to be owing to 
an accumulation of calcium oxalate. The blood through- 
out the body is fluid. A few cases have occurred where all 
morbid appearances have been absent. 

Analytic Methods. — (i) As a solid. When pure, it occurs 
in colorless four-sided crystals, of an intensely sour taste 
(by which it is immediately distinguished from magnesium 
sulphate), soluble in water, especially hot; soluble, also, in 
alcohol, but insoluble in ether, and nearly so in chloroform. 
It is completely volatilized by heat, leaving no residue ; this 
is not the case with the magnesium and zinc sulphates, for 
which it has been mistaken. 

(2) As a Liquid. — It reddens litmus paper ; a drop evapo- 
rated to dryness leaves long, slender prisms, (a) Silver 
nitrate gives a copious white precipitate of silver oxalate, 
distinguished from the chlorid and cyanid by being soluble 
in cold nitric acid. If this precipitate is thoroughly dried 
and heated on platinum foil, it is completely dissipated in a 
white vapor, in a succession of puffs or slight detonations. 
(b) Calcium sulphate gives a white precipitate of calcium 
oxalate, which is distinguished from the carbonate and 
phosphate by being insoluble in acetic acid, but being solu- 
ble in nitric, and rather less so in hydrochloric acid. Cal- 
cium sulphate will also precipitate solutions of barium, 
strontium, and lead ; but these sulphates are insoluble in 
nitric acid, (c) Barium chlorid, strontium nitrate, and lead 
acetate all precipitate white crystalline oxalates, which are 
soluble in nitric and hydrochloric acids ; but these tests are 
of inferior value to the former ones, (d) Copper sulphate 



OXALIC ACID TOXICOLOGIC EXAMINATION. 5 I I 

yields a faint bluish-white cupric oxalate, which is almost 
insoluble in nitric acid. 

Toxicologic Examination. — If the contents of the stomach 
are highly acid, the poison may probably be separated by 
dialysis, or by digestion with distilled water, at a moderate 
heat, for some hours, and then filtered, the filtrate concen- 
trated, and tested with copper sulphate. If this test affords 
evidence of the presence of oxalic acid, the liquid may be 
evaporated to crystallization, and the crystals thus obtained 
redissolved in pure alcohol, and the solution again crystal- 
lized. 

It is usually recommended to treat the first filtrate with 
an excess of solution of lead acetate; wash the precipitated 
lead oxalate on the filter ; then diffuse it thoroughly in pure 
water, and pass through it a current of washed hydrogen 
sulphid, until all the lead and organic matter is thrown 
down. Heat a little while, to expel the excess of hydrogen 
sulphid, then filter, and crystallize the filtrate by evapora- 
tion. Purify the crystals, if necessary, by resolution, and 
apply the usual tests. 

It may happen that all the oxalic acid in the stomach has 
been neutralized by the antidotes that were administered, 
— lime or magnesia, — in which case the contents of the 
stomach would not be acid. Here, the inspected solids 
should be collected, and thoroughly washed with warm 
water and the liquid decanted off; if this liquid is acid, it 
should be reserved for examination ; if not acid, it may be 
thrown away. The solids should then be diffused in pure 
water, and boiled for some time with pure potassium car- 
bonate, which decomposes the oxalates, forming soluble 
potassium oxalate and insoluble calcium carbonate and 
magnesium carbonate. These are separated by filtration, 



5 I 2 TOXICOLOGY. 

and the solution concentrated by gentle heat, until the 
crystals are formed. 

In a case of alleged oxalic acid poisoning it might be 
objected that the presence of a minute quantity of oxalic 
acid found in the stomach after death might be due to 
rhubarb or sorrel that had been eaten by the deceased. 
The answer to this is that if there is an entire absence of 
all the characteristic symptoms of this active poison, the 
discovery of a small quantity of the acid is certainly no 
evidence of poisoning; but, on the other hand, if the pecu- 
liar symptoms of this poison and morbid lesions are present, 
then the obtaining of only a small amount of the acid should 
not negative the suspicion of poisoning. 

In a case of suspected poisoning by oxalic acid, the urine 
should always be examined for an increase of the octahedral 
crystals of calcium oxalate. This fluid should be collected 
in a conical glass, and the sediment which collects after 
some time should be examined with the microscope. 

It should, however, be remembered that these crystals 
may be found in the urine of persons who have partaken of 
food such as rhubarb and sorrel, containing oxalates. 

To detect free oxalic acid, or a soluble oxalate in the 
urine, add a little acetic acid to dissolve out the phosphates, 
if present, and concentrate to about one fourth its bulk, then 
add lead acetate in excess, and filter ; decompose the lead 
oxalate with hydrogen sulphid, and treat the filtered solu- 
tion as above directed. 

Stains of this acid on cloth, parchment, paper, etc., may 
be discovered by boiling them in water, and applying the 
usual tests. The color of these stains on black cloth is 
orange and brownish-red. This acid is sometimes em- 
ployed to remove writing ink, in cases of forgery ; but usu- 



BORIC ACID AND BORAX. 5I3 

ally there are left on the paper traces of iron, existing in the 
ink, which can readily be recognized by applying a solution 
of potassium ferrocyanid, which will turn it blue. 

Oxalic acid is usually estimated quantitatively as lead ox- 
alate or calcium oxalate ; lOO parts of the dried pure lead 
oxalate are equivalent to 42.6 of the crystallized acid, 100 
parts of dried pure calcium oxalate to 98.3 of the crystallized 
acid. 

Calcium oxalate is almost invariably found in the urine 
in the form of octahedral crystals, and often in larger masses 
constituting ''mulberry" calculus. 

Acid Potassium Oxalate — (Salt of Sorrel — Essential 
Salt of Lemoivs). — This salt is much used in the arts. It 
is almost as active a poison as oxalic acid ; the symptoms, 
dose, and lesions are very similar to those of the acid. It 
is distinguished from the latter (i) by heating a fragment 
on platinum foil ; an ash is left, potassium carbonate, while 
the acid is entirely dissipated; (2) it crystallizes in feathery 
forms; (3) it is distinguished from cream of tartar by lime 
water, which precipitates both ; but the calcium tartrate is 
immediately redissolved by tartaric acid, while the oxalate 
is insoluble. This salt is a natural ingredient in the sorrel. 

Tartaric and Acetic Acid act as powerful irritant poisons, 
in the concentrated state, and in large doses. They have 
both produced fatal results when taken in doses of an 
ounce. Their proper antidotes are the alkaline carbonates, 
and chalk or magnesia. 

Boric Acid and Borax. — There appears to be no evi- 
dence that borax has produced serious results, although 
probably in very large doses it would act as an irritant. 



5 1 4 TOXICOLOGY. 

Small doses of it may be taken for a considerable time 
without apparent injury. The same is true of boric acid, 
but the liberal use of this in medical and surgical practice 
has led to disturbances of function in persons otherwise in 
bad health. Mixtures of boric acid and borax containing 
about seventy per cent, of the latter are much used as food 
preservatives especially for butter, meat and milk. The 
following cases have some interest but it must be noted that 
the quantities taken were much larger than those which 
would be found in food. Some cases of fatal result after 
very large doses of boric acid in persons seriously ill have 
been reported. 

A man, aged 38 years, took every 4 hours five grains of 
boric acid by the mouth, and also had the bladder washed 
out with a 3-per-cent. solution. After several days the 
patient became very weak, with small pulse and a papulo- 
vesicular eruption appeared on the backs of the hands and 
fingers. The symptoms disappeared on withdrawing the 
use of the acid and returned on restoring it. In a second 
case, a man, 50 years old, who had just been operated on 
for stone in the bladder, took the same doses as the above 
and at the 14th day exhibited weak pulse, nausea, tempera- 
ture 102.2° F., unsteadiness and an eczematous eruption 
over the whole body. On discontinuing the acid the symp- 
toms disappeared and reappeared in two days on resuming it. 

A report of a case of fatal boric-acid poisoning, of which 
the following is an abstract, was made by Charles L. Best, 
M.S., of Chicago (/. Amer. M. A., Sept. 17, 1904). A man, 
aged 36, suffering from suppurative inguinal lymphadenitis, 
bilateral otitis media and right suppurative mastoiditis, was 
treated for the first-named trouble by free excision of the 
inguinal glands, the wound washed with salt solution, packed 



BORIC ACID AND BORAX. 515 

witli six ounces of boric acid powder and sealed with col- 
lodion. After the operation repeated vomiting of a green- 
ish-yellow fluid occurred, which ultimately became uncon- 
trollable. On the third day, a diffuse erythematous, and 
papular rash appeared on the neck, chest and shoulders, 
with a distinct line of demarcation at the clavicle. The fol- 
lowing day a more diffuse papular rash appeared on the back 
and thighs. There was no pustule formation. The skin 
about the operation-wound was red. On August 20, i a. m., 
there was marked cyanosis, a clammy sweat, cold feet, weak, 
irregular pulse and uncontrollable vomiting. Delirium set 
in during the last few hours before death. The patient died 
at 7 a. m., August 20. The rash was still visible. The 
temperature had increased with slight remissions from 98.4 
on admission to 100.8, with a fall of 0.6 just before death. 
The pulse increased from 68 on admission to 138, with a 
decrease of 12 just before death. Respiration on admission 
was 16, which increased to 38 just prior to death. 

Autopsy. — An autopsy was held three hours later by Dr. 
H. G. Wells. The body was that of a well-developed, well- 
nourished man, 165 cm. in length, not yet cold, but rigor 
mortis was present. The skin was white except for a pur- 
plish tinge above the clavicle and on the right side of the 
scrotum, and a brownish discoloration about the inguinal 
wound where the epidermis was elevated by a large quantity 
of serous fluid. The pericardium showed innumerable 
minute subpericardial extravasations of blood, from which 
the parietal layer was free. 

The musculature of the heart was normal, likewise the 
valves, and the vessels were free from sclerosis. 

The gall bladder was distended, containing a dark, tarry 
bile, but no calculi were present. The liver was enlarged, 



5 1 6 TOXICOLOGY. 

weight 2,500 grams, pale and friable, and on the cut surface 
only the centers of the lobules appeared normal, the peri- 
pheries being pale. 

The adrenals showed no change. The kidneys showed a 
thick, fatty capsule, were of normal size and consistence and 
showed remnants of fetal lobulation. The cortex was pale 
and the markings fairly distinct. The capsule stripped 
readily, leaving a smooth surface. 

The surfaces of the gastrointestinal tract were normal. 

The cranial cavity showed a moderate amount of fluid, the 
longitudinal sinus containing a soft, dark clot, not adherent. 
The brain substance was normal. No change in meninges, 
skull nor the adjacent sinuses. 

CARBOLIC ACID. 

Carbolic Acid — (Phenic Acid — Phenol) — is one of the 
products of the distillation of coal tar. When pure, it is in 
the form of white acicular crystals, and can also be obtained 
by synthesis, which, when exposed for some time to the 
lights usually acquire a reddish tinge. They have a strong 
affinity for water, and liquefy when exposed to the air. It 
is not, however, very soluble in water ; much more so in 
alcohol, ether, and glycerol. It has a burning taste, and a 
peculiar, strong, creasote-like odor. It is sometimes called 
coal-tar creasote. It is powerfully antiseptic, quickly de- 
stroying minute organisms. Applied in its undiluted state 
to the skin, it acts as a corrosive and anaesthetic, cor- 
rugating and hardening it. Taken internally, undiluted, its 
effects are those of an energetic, corrosive, and neurotic 
poison. 

Carbolic acid, from its extended employment in indus- 
tries, etc., has of late years become a very frequent cause 
of poisoning. 



CARBOLIC ACID — TREATMENT. 5I7 

Symptoms. — Intense burning pain in the mouth, throat, 
and stomach; the pupils are contracted; the conjunctiva 
insensible to the touch; marked odor of the acid exhaled 
from the breath ; the skin cold and clammy ; the tempera- 
ture rapidly falls ; the pulse becomes weaker and weaker, 
but fluctuates in its beats; respiration is labored, and ulti- 
mately stertorous ; vomiting of a frothy mucus sometimes 
occurs ; the mouth is white and hardened from the local 
effects of the acid. Coma usually precedes death, which 
may also sometimes be accompanied by convulsions. Death 
may occur within an hour from swallowing the poison; in 
one case, within ten minutes. The urine, as shown by 
Stevenson, is often of an olive-green color. 

Many of the above symptoms have been produced by 
the external application of the acid, especially to denuded 
surfaces. 

Fatal Dose. — Dangerous symptoms have occurred from 
doses of six or seven drops or grains. The deaths recorded 
have resulted from doses of one to two ounces ; but a much 
less quantity would certainly prove fatal. 

Treatment. — The stomach should be washed out with 
demulcent liquids. A solution of lime in strong syrup 
(saccharated lime) may be used as a neutralizing agent. 
Sodium sulphate is regarded by some as a true antidote. 
Solution of soap may also be employed. Oil is the best 
outward application to the skin. Stimulants and strychnin 
may be given to combat the collapse. Alcohol is the 
best antidote. When the skin or mucous membrane of 
the mouth has been injured by phenol, the prompt use 
of strong alcohol will remove the blanched appearance and 
prevent an eschar. When the poison has been swallowed, 
whiskey may be used with advantage. It is also claimed 



5 I 8 TOXICOLOGY. 

that vinegar is an antidote. A mixture of cream and mag- 
nesium sulphate is recommended. 

Post-mortem Lesions. — The mouth and esophagus are 
usually white, soft, and corroded, but sometimes hardened 
and corrugated. The brain is generally normal, but occa- 
sionally congested, the fluid in the ventricles exhaling the 
strong odor of the acid. The lungs are usually gorged with 
blood. The left ventricle of the heart is generally contracted, 
while the right is flaccid. The blood is uniformly dark- 
colored and fluid. The odor of carbolic acid is detected in 
the stomach, sometimes in the intestines, and even in the 
other viscera. The mucous lining of the stomach has been 
found white, hardened, and wrinkled; but, again, highly 
congested and corroded. The bladder is usually empty, any 
urine passed being of a dark or olive-green color. 

Analytic Methods, — The odor is probably the best test. 
Phenol has a slight acid reaction, forms salts with bases and 
imparts a transient, greasy stain to paper. It coagulates 
albumin. It gives a deep violet color to ferric chlorid, and 
a bluish tint to a mixture of ammonium hydroxid and 
sodium hypochlorite; if this be acidulated, it turns red. 
Bromin water causes a whitish-yellow flocculent precipitate ; 
if this be treated with sodium-amalgam, carbolic acid is set 
free (Landolt). Heated with potassium cyanid, it gives a 
red tint. A splinter of wood, moistened with the acid, and 
afterward dipped into nitric or hydrochloric acid, turns of a 
greenish-blue tint when dry. 

Toxicologic Examination. — Generally, the characteristic 
odor of the acid will be perceived in the body after death. 
The organic matters should be distilled along with dilute 
sulphuric acid. 

Carbolic acid can generally be detected in the urine, both 



LYSOL. 5 1 9 

by the odor and by chemical reagents. The urine may 
either be distilled without sulphuric acid (as it is said this 
acid may develop carbolic acid from some of the normal 
constituents of the urine) ; or by agitating it with an excess 
of ether, and subsequently removing the ethereal layer by 
means of a pipette, and evaporating in a shallow dish, a 
minute oily residue is left, having the character of carbolic 
acid. 

Resorcinol (metadihydroxybenzene). — Poisoning by the 
external application of this substance has been reported by 
Dr. S. Kaiser (Therap. Monatsheft., Oct., 1905, p. 540). A 
patient, affected with Lupus vulgaris, was ordered a resor- 
cinol plaster, and afterwards an ointment of zinc oxid and 
resorcinol was applied. Burning pain and profuse sweating 
occurred soon. The physician removed the application 
within an hour ; by that time the patient was apparently un- 
conscious, but shrieked furiously and had clonic spasms. 
The pulse and respiration were very rapid. These condi- 
tions lasted ten minutes when opisthotonos supervened. 
Alternate spasms and relaxations occurred at brief intervals. 
In about an hour the patient became quiet, being still un- 
conscious. The pulse soon began to improve and conscious- 
ness returned. Urine voided three and one half hours after 
the application of the drug was greenish and became black 
on exposure to air. Phenol was detected in it, but no albu- 
min. In four days the patient had apparently fully re- 
covered. The report does not mention any treatment. 

Lysol. — Lysol is a coal-tar product containing a consid- 
erable amount of cresols (methyl-phenols) which have been 
converted into sodium salts and thus made freely soluble 
in water. It is much used as an antiseptic wash. Several 



5 20 TOXICOLOGY. 

cases of poisoning have occurred in consequence of the solu- 
tion being mistaken for other drugs. A child of nearly two 
years drank at 8 P. M., probably about a teaspoonful of lysol. 
Milk was given immediately, but unconsciousness soon 
supervened, without cramps or vomiting. At 8.15, when 
the physician saw her, the pulse was 160, small and ir- 
regular, cyanosis marked, pupillary and corneal reflexes 
absent. The mouth contained considerable mucus. The 
extremities were insensitive. There was corrosion of the 
skin at the corners of the mouth, on the chin and of the 
mucous surface of the mouth. The lungs were edematous. 
At 8:30 P. M. the stomach was washed out with half a 
gallon of water, the last portions of which gave no odor of 
lysol. Camphor and ether injections were used. A few 
hours later the pulse was improved, the cyanosis and edema 
of the lung almost gone, the pupils began to respond to light, 
and consciousness slowly returned. During the night, sev- 
eral attacks of vomiting occurred and the next morning she 
was fully conscious, had a temperature of 102.2°, a pulse 
of 120, regular and moderately strong ; but marked dyspnea. 
The edema of the lung increased greatly, she became un- 
conscious, with almost imperceptible pulse, and died at 3 
P. M., 19 hours after taking the poison. No post-mortem 
could be obtained. 

Experience in lysol poisoning shows that prompt use of 
the stomach pump was followed by the recovery of all the 
patients, while the neglect of this measure was almost invari- 
ably fatal. Solution of lysol should never be stronger than 
I per cent, for external application and .5 per cent, for irri- 
gating internal cavities. It should never be used long at 
a time. One death has been known from the external ap- 
plication of pure lysol on the intact skin. It is adminis- 



SODIUM SALICYLATE. PYROGALLOL. 52 1 

tered internally, the minimal dose should be taken as the 
standard, and it should never be given except for a brief 
period, and better not at all in case of children or feeble 
patients. In the i8 cases collected, poisoning occurred in 
13 from internal and in 5 from external use of the agent. 
Nine of the patients died, 5 children and one adult after 
internal administration, and 2 adults and one child after 
the application of pure lysol externally, by mistake for the 
i-per-cent. solution that had been ordered. The largest 
dose from which the patient recovered was 60 grams (925 
grains), taken by a woman, and 25 grams (385 grains), by 
a four-year-old child. The smallest dose that proved fatal 
was a teaspoonful, about 4 to 5 gm., of pure lysol, in chil- 
dren from five to eight years old. 

Pyrogallol. — Pyrogallol is a benzene derivative, closely 
allied to phenol and resorcinol. It is much used as a de- 
veloper in photography, but cases of poisoning by it are rare. 
The following instance was described by Kusch. A woman 
in the seventh month of pregnancy, suffering from psoriasis, 
used on successive days an ointment of lo-per-cent. pyro- 
gallol. On the fourth day alarming symptoms developed, 
including marked dermatitis, ashen paleness of face, dysp- 
nea and very dark urine without blood or albumin. The 
temperature was 37.2° C. (99° F.), the pulse regular and 
strong. As the condition was not improved on the suc- 
ceeding day, premature labor was induced and a macerated 
fetus removed. The patient recovered. 

Blindness from Sodium Salicylate. — Snell has reported 
the case of a girl who, after taking about 150 grains of 
sodium salicylate, became totally blind. When Mr. Snell 
saw her she was in a dying condition from heart disease due 

45 



522 TOXICOLOGY. 

to rheumatism, but the fundus was apparently normal. She 
died soon after without recovery of sight. A few such cases 
are on record. 

Betanaphthol. — A man, aged 40, who had used a 3 per 
cent, vaseline ointment of naphthol for two weeks for treat- 
ment of eczema, experienced such irritation of the eyes 
that the ointment was discontinued. Six months afterward, 
double cataract appeared and also retinal disturbance. Ex- 
periments on animals showed that the external application 
of the naphthol produces similar disturbances. Benzo- 
naphthol produced retinal trouble with hyperemic papillae. 
Naphthol seems to be more injurious than naphthalene, 
although the latter is also toxic. 

Naphthalene. — Naphthalene, the well-known substitute 
for camphor as an insectifuge, was observed by Lezenius to 
give rise to cataract. The following is the case: A man, 
36 years old, was ordered, for an intestinal affection, a mix- 
ture of 5 grams {yy grains) of naphthalene and 200 grams 
(about 3,000 grains) of emulsion of castor oil. The compo- 
sition of the emulsion is not given. The patient took the 
entire amount of the mixture within thirteen hours. Nine 
hours thereafter he was awakened, after a quiet sleep, by 
severe pain in the bladder and found that he was blind. 
An examination of the eyes showed narrowing of the field 
of sight capacity to distinguish fingers at 1.5 meters (5 feet), 
turbidity of both lenses (which appears as if sprinkled with 
a white substance by means of camel's-hair pencil), and 
narrowing of the retinal arteries. The lenses were extracted. 
It was learned that the naphthalene was not pure, but the 
nature of the foreign matter is not stated in the report. 

Kerosene and Gasolin. — Cases of severe intoxication with 
insensibility sometimes followed by mania, due to the drink- 



POISONING BY CROTON OIL. 523 

ing of gasolin or inhalation of its vapors are not uncom- 
mon in large cities. Two cases of gasolin poisoning oc- 
curred among sailors in the Santiago blockading fleet in 
1898. They obtained the gasolin from one of the launches. 
One man died and the other became insane. Poisoning by 
kerosene is common in some parts of India. Dr. C. J. 
Robertson-Milne, of Calcutta, reports fifteen cases, several 
of them in children less than three years old. The follow- 
ing notes are from his report : 

Symptoms of Kerosene Poisoning. — Vomiting followed by 
signs of collapse, chiefly circulatory. Odor of the breath 
markedly that of kerosene. 

Treatment. — The stomach should be washed out with 
warm water. Other treatment is mainly symptomatic. The 
patient should be kept under observation for at least twelve 
hours and the possibility of a sudden fatal issue never lost 
sight of. 

POISONING BY CROTON OIL, ELATERIUM, CASTOR 

BEANS, COLCHICUM, SAVIN, OLEANDER AND 

WORMSEED. 

Croton oil is a fixed oil, extracted by pressure from the 
seeds of Croton tigliiim. It is used in medicine as a power- 
ful purgative, in doses of one or two drops. In overdoses, 
it acts as a violent irritant to the gastro-intestinal mucous 
membrane, causes excessive vomiting and purging, followed 
by collapse, as in cholera. Its poisonous properties seem 
to be dependent on a peculiar fatty acid named crotonic, 
which exists in the oil in variable quantities. When deprived 
of this acid the oil is harmless. 

Croton oil is of a light yellow color, has an unpleasant 
odor, and a hot, acrid, burning taste. Another variety has 



5 24 TOXICOLOGV. 

a darker color. It is very soluble in ether. Nitric acid, 
with the aid of heat, imparts to it a dark-brown color. 

Death has resulted in one case from taking, by mistake, 
an embrocation containing thirty minims of the oil. In 
another case, two and a half drachms proved fatal in four 
hours ; while in a third instance, half an ounce of croton oil 
was taken by mistake, and after exciting violent vomiting 
and purging, with symptoms of collapse, the patient recov- 
ered after fourteen days. 

Dr. Reese attended a case of accidental poisoning by this 
substance, arising from swallowing an embrocation contain- 
ing at least one drachm of the oil. The patient, a young 
lady, recovered after experiencing very severe symptoms. 

This oil has occasionally been administered with a poison- 
ous intent, in successive small doses, so as to produce 
symptoms resembling those of gastro-enteritis. A case of 
this character was tried at Mount Holly, N. J., in which 
a woman was convicted of an attempt to poison her son, 
for the purpose of obtaining his life-insurance money. The 
purchase and possession of the poison were ascribed by the 
defendant to having been intended by her for the cure of 
her corns. 

Analysis. — Separate the oil from the contents of the 
stomach by means of ether, and evaporate the ethereal solu- 
tion spontaneously, and test the resulting oil with nitric acid 
and heat. 

Elaterium. — This substance is procured from the juice 
of Echallium ofUcmariim, or squirting or wild cucumber. It 
is used in medicine as a powerful drastic purgative. Its 
effects are very similar to those of croton oil. One grain of 
good elaterium has produced very violent effects. It owes 
its activity to a neutral resinous principle, elaterin. Nitric 



COLCHICUM. 525 

acid has no action upon it. Sulphuric acid turns it of a 
reddish-brown color. 

Castor Beans are derived from the Ricimis communis, 
and yield by pressure the castor oil of commerce. The 
seeds contain an irritant, poisonous principle, which causes 
them to act violently when swallowed. They have occa- 
sionally proved fatal. In one case three seeds destroyed 
life in an adult male in forty-six hours, and twenty seeds 
proved fatal to a young lady in five days, after violent 
symptoms, strongly resembling those of malignant cholera. 

Colchicum. — The Colchiciim aiitumnale , or meadow saf- 
fron, contains a powerful alkaloid principle, colchicin, which 
strongly resembles veratin in many of its properties. It 
abounds chiefly in the bulb of the plant, but is also found in 
the seeds. 

The effects of a large dose upon the system are those of 
a violent irritant, such as burning pain in the throat and 
stomach, great thirst, vomiting, and soreness, purging, 
cramps, cold, collapsed skin, feeble pulse, dilated pupils, 
suppression of urine, and rapid exhaustion. Sometimes 
there are delirium and convulsions. 

The strength of the preparations of colchicum varies 
greatly, depending upon the time of gathering the plant, 
and also upon its place of growth. 

Death has resulted in seven hours, and again has been 
delayed for several days. Generally, it occurs within 
twenty-four hours. Less than half an ounce of the wine of 
the root, forty-eight grains of the dried bulb, and a table- 
spoonful of the seeds have severally proved fatal. Accidental 
poisoning occurred in Montreal, in 1873, in a company of 
eight or nine persons. They had freely partaken of what 



526 TOXICOLOGY. 

they supposed to be ordinary wine, but which was really 
wine of colchicum. In the course of a few hours they 
became alarmingly ill, with nausea, vomiting, excruciating 
pains, purging, cramps, and prostration. Five of the cases 
terminated fatally within thirty-six hours. 

Post-mortem Appearances. — These consist of inflamma- 
tion of the stomach and bowels. In some instances no 
morbid appearances exist. In one case the pia mater was 
much congested, when there was an absence of inflamma- 
tion from the stomach. The lungs are usually deeply con- 
gested. 

Colchicin occurs in fine, white crystals. It is soluble in 
water, has a feeble, alkaline reaction, and a bitter, acrid 
taste. Its best test is nitric acid, which gives it a violet color, 
changing to blue and brown. It differs from veratrin in 
its negative action with sulphuric acid. It may be re- 
covered from organic mixtures by a modification of Stas' 
process. Less than half a grain of colchicin has proved 
fatal. There is no direct antidote. 

The following case has been recently reported. A man 
aged 40, who had for a long while suffered from gout, 
had been directed to take occasionally a granule of one 
milligram (one sixty-fifth of a grain) of colchicin. Finding 
much relief he had taken four or five of the granules per 
day. For some time he felt no special inconvenience, ex- 
cept 8 to 10 movements of the bowels daily. He developed 
the following symptoms which were exhibited when the 
physician saw him. For 36 hours he had been almost un- 
able to move and was nearly voiceless. The skin was cool 
and the temperature below normal. There was thirst and 
nausea. The pulse was small and thready. The urine was 
much reduced in amount, but free from sugar or albumin. 



SAVIN. 527 

The bowel-movements were 30 to 40 in the day and profuse, 
containing white flocculent matter. A tendency to vomiting 
was also exhibited. Frequent spasmodic movements of the 
general muscular system occurred, and touch excited violent 
and painful contractions. The pupils were not affected and 
the speech was not disordered. The patellar reflexes were 
increased. It was evident that a condition of chronic poison- 
ing by colchicin had been developed. The use of the drug 
was stopped, injections of artificial serum and spartein sul- 
phate were employed and a milk diet advised. The con- 
ditions noted above lasted for 24 hours, when an abundant 
secretion of urine was established, the muscular symptoms 
abated steadily and passed away in about 50 hours, and the 
profuse diarrhea also ceased. It seemed that the patient was 
out of danger, but on the fifth day the physician was sud- 
denly recalled to find the man suffering from fever (tem- 
perature, 103° F.) and swelling of the joints with severe 
pain. The urine was of moderate quantity but there was 
no bowel-movement. Various salicylates were administrated 
and a strict milk diet ordered. The normal condition was 
restored in several weeks. 

Savin. — The tops of the Jiiniperus sabina contain a vola- 
tile yellow oil (oil of savin), which may be procured by dis- 
tillation. Both powder and oil are employed in medicine, 
and both possess powerful irritant properties. They are 
seldom or never used as poisons, but they frequently pro- 
duce fatal results when used as abortives. Although not 
believed to possess specific ecbolic properties, uterine con- 
tractions may follow their powerful irritant effects upon the 
gastro-enteric mucous membrane ; but death is a more fre- 
quent result without the expulsion of the fetus. 



5 28 TOXICOLOGY. 

In cases of poisoning by the powder this may often be 
discovered in the stomach and bowels by microscopic in- 
spection. The oil may be separated by distillation from the 
contents of the stomach, and then agitating the distillate with 
ether, in which it is soluble, and allowing the solution to 
evaporate. It is recognized by its peculiar terebinthinate 
odor. 

Oleander Leaves. — The leaves of a species of oleander 
are used in Bulgaria in the treatment of malaria and as an 
emmenagogue. Dr. S. Wateff saw, at Sofia, the following 
case: An 1 8-year-old girl, suffering from gastralgia, pre- 
pared an infusion of forty oleander leaves in 200 c.c. (about 
six fluid-ounces) of hot water, and drank about half this 
liquid. She noticed at once a bitter taste and nausea; 
vomiting soon occurred and severe headache set in. She 
fell to the ground, although not unconscious, but the pain 
and vomiting continued. The face felt hot, she had pain 
about the heart, a sense of oppression and the hands were 
cold and blue. A physician attended her some hours after 
the poison was taken. He washed out the stomach and sent 
her to the hospital, where in a few hours the stomach was 
again washed out. Everything given by the mouth was 
promptly rejected. The consciousness was not disturbed; 
the pulse was very frequent and the temperature was nor- 
mal. On the following day the visible mucous membranes 
were all strongly reddened, the face bright scarlet, the pupils 
much contracted but reacted to light. The heart-beats were 
weak, but nothing abnormal was noted in the lungs. The 
pulse was forty per minute; the respiration 26; the tem- 
perature slightly subnormal. The abdomen was slightly re- 
tracted, sensitive in the region of the stomach and umbilicus. 



WORMSEED. 529 

During ten hours 100 c.c. of urine were passed, of specific 
gravity of 1022, alkaline, and free from albumin and sugar. 
Headache, thirst, nausea and vomiting continued. The next 
day the patient was able to retain a purgative, which pro- 
duced an abundant evacuation. The nausea passed away 
slowly, but the pulse remained slow for several days, sink- 
ing at one time to 32. On the twentieth day after taking 
the poison the pulse was 65. The inquiries provoked by this 
case showed that three instances of oleander poisoning had 
previously occurred in Sofia, all being in women who had 
used the leaves as abortifacients. All the patients showed 
vomiting, slow pulse, dilatation of the pupils and premature 
menstruation, without diarrhea. Dr. Wateff further reports 
that the members of a family were affected with headache, 
nausea and slowness of pulse, which conditions were ascribed 
to the fact that many oleanders were kept in the house 
during the entire winter. On removing the plants the symp- 
toms ceased. The emanations from the plants had caused 
the trouble. 

Wormseed. — The seeds of several species of Chenopodium 
contain an oil much used as a remedy for the intestinal round 
worms frequent in children. The oil is used freely, being 
generally regarded as safe, but some cases of severe poison- 
ing by it are recorded. Marked muscular weakness, in- 
sensibility, and clammy skin, with disturbances of hearing 
are reported. The poison seems to act as an irritant and 
narcotic, but in most of the recorded cases definite informa- 
tion is lacking as to the amount taken and the quality of 
the oil. In one case, a boy aged three years died after taking 
a teaspoonful of the oil. He vomited and became uncon- 
scious. The pupils were small, but the pulse, respiration 
46 



5 30 TOXICOLOGY. 

and temperature were normal. The remedies used were 
salt water (as an emetic), calomel and castor oil. He passed 
into a deep stupor, had convulsions and died. 

The best treatment will probably be early and free washing 
out of the stomach. Strong coffee might be useful. Irri- 
tating emetics and purgatives should be avoided. 

VERATRIN — YELLOW JASMINE — GELSEMIN AND GEL- 
SEMIC ACID — POISONOUS MUSHROOMS. 

Black Hellebore (Helleborus niger), formerly named 
Melampodium, is sometimes employed in medicine. It is 
a powerful irritant to the stomach and bowels, and has 
proved fatal in overdoses, occasioning violent vomiting, 
purging, abdominal pain, cold sweats, collapse, and con- 
vulsions. 

Green Hellebore ( Veratrum^ viride — American- Hellebore 
— Indian Poke). — This species possesses very active prop- 
erties, and has occasioned fatal results. The tincture is used 
in medicine as a powerful cardiac depressant. Numerous 
fatal results have followed its incautious use. Several 
active alkaloidal principles exist in both this drug and in 
V. album — which, though resembling veratrin in some 
points, are distinct from it. 

White Hellebore (Veratrum album). — This is the most 
poisonous of all the hellebores. The powder produces 
violent sneezing. Taken internally, it causes a sense of 
burning heat and constriction of the throat, great anxiety, 
nausea, vomiting, and purging, pain of the abdomen, 
trembling of the limbs, great prostration, cold sweats, very 
feeble pulse, dilatation of the pupils, giddiness, convulsions, 
insensibility, and death. Death has occurred in three and 
six hours after taking it. The active principle is Veratrin. 



POISONING BY HELLEBORE. 53 1 

Veratrin. — This alkaloid, as above mentioned, exists in 
the V. album and V. viridc, but it is usually procured from 
the seeds of Veratnim sahadilla. As found in the shops, it 
is in the form of a white powder. It may be crystallized 
with difficulty. It has an acrid, bitter taste, followed by 
a sense of dryness in the throat. It is a violent irritant to 
the nostrils, causing excessive sneezing. It is insoluble in 
water, soluble in alcohol, ether, chloroform, benzene, and 
amylic alcohol. Heated on porcelain it melts and blackens, 
evolving a pungent vapor. 

Effects. — Taylor mentions the case of a lady on whom 
the yV of ^ grain occasioned most alarming symptoms, such 
as insensibility, cold sweats, failing pulse, and collapse. It 
acts as a local irritant to the stomach and bowels, and at the 
same time as a general depressant. 

Analytic Methods. — The characteristic test is sulphuric 
acid. A drop applied to the pure alkaloid imparts a yellow 
color to it, followed by a reddish tint, which gradually 
passes to a deep crimson. This change is brought about 
immediately by heat. Even a very dilute acid causes this 
reaction by evaporating to dryness. It is stated that even 
less than the ^-ir^-frTj- of a grain of veratrin may be thus de- 
tected. 

Other substances give a red color to sulphuric acid — such 
as solanin, narcein, salicin, piperin, etc. ; but these are im- 
mediately colored by cold sulphuric acid, whereas veratrin 
requires the lapse of some time before the change is effected. 

Other reagents are gold chlorid, bromin in hydrobromic 
acid, and iodin in potassium iodid. 

Trapp's test consists in warming the colorless solution 
of veratrin in concentrated hydrochloric acid, when a per- 
sistent dark-red color results. 



532 TOXICOLOGY. 

In organic mixtures, veratrin may be separated by a 
modification of Stas' process, and the ultimate chloroform 
extract tested by sulphuric acid. Wormley states that by 
this test he was enabled to recognize the presence of vera- 
trin in an ounce of blood of a cat which had been killed, in 
less than one minute, by two grains of veratrin. 

Yellow Jasmine (Gelsemium sempervirens) . — The root 
of this plant is considerably employed in medicine, espe- 
cially in the Southern States of our country, in the treat- 
ment of neuralgia and analogous complaints. It has fre- 
quently produced fatal results, the symptoms somewhat 
resembling those produced by veratrin. 

The most prominent of these are dimness of vision; the 
motor nerves of the eye are attacked first; objects cannot 
be fixed; the eyelids become paralyzed, droop, and cannot 
be voluntarily raised; pupils are dilated; eyes staring; face 
congested, though sometimes pale; lips livid; tongue thick, 
speech impaired ; partial paralysis of the legs ; much gen- 
eral prostration ; small and frequent pulse ; breathing slow 
and labored. Sometimes there are spasms of the throat; 
and after large doses tetanic convulsions have been observed. 

The time when the symptoms appear varies from a few 
minutes to an hour or more ; and fatal results have occurred 
in one hour up to several. 

Fatal Quantity. — The tincture and fluid extract are offi- 
cinal preparations. The latter is about four times stronger 
than the former. Twelve minims of the fluid extract proved 
fatal to a child three years old ; and thirty-five drops of the 
tincture caused death in another case in an hour and a half. 
A teaspoonful of the fluid extract and half an ounce of the 
tincture may be considered as fatal doses. 

Treatment. — Speedy evacuation of the stomach, followed 



GELSEMIN. 533 

by stimulants, internal and external. The hypodermic use 
of large doses of morphin is strongly recommended; also 
the use of electricity. 

Wormley succeeded, in 1870, in isolating two distinct 
principles from the G. sempervireits — gelsemin and gelsemic 
acid. 

The former is a strong alkaloidal, nitrogenized base, and 
constitutes about 0.25 per cent, of the dried root; the 
latter is a non-nitrogenized body, crystalline and feebly acid. 
Its proportion in the root is about 0.5 per cent. 

Gelsemin is a colorless, odorless, difficultly crystallizable 
solid, persistently bitter to the taste, slightly soluble in water 
and alcohol, very soluble in chloroform, ether, bisulphid 
of carbon, and benzene. It forms soluble salts. 

Sulphuric acid dissolves it without change of color if 
perfectly pure ; but as commonly found, it slowly colors it 
brown, which changes to a purple if warmed. If a frag- 
ment of potassium dichromate be stirred in the acid solution, 
a red color is produced, which soon changes to a blue tint. 
In this respect it somewhat resembles the reaction of strych- 
nin; but they can readily be distinguished by the action of 
nitric acid, which gives to gelsemin a bluish-green color 
when evaporated, but does not affect strychnin. These are 
the most satisfactory modes of recognizing gelsemin. 

Gelsemic Acid. — A colorless and nearly tasteless solid, 
crystallizing in tufts or needles ; slightly soluble in hot 
water, very soluble in ether and chloroform. Its nitric acid 
solution, when treated with ammonium hydroxid, develops 
a deep-blood-red color, even in very minute proportions. 

Its sulphuric acid solution when acted upon by ammo- 
nium hydroxid immediately produces a mass of needle- 
shaped crystals. This is an exceedingly delicate test. Its 



534 TOXICOLOGY. 

fluorescent properties also characterize gelsemic acid, in the 
presence of an alkali. An extremely minute quantity may 
thus be recognized. 

The above two bodies may be extracted from organic 
mixtures, as the contents of the stomach, by the usual proc- 
ess pursued for the alkaloids. The resulting filtered acid 
solution should be taken up with ether, which will remove 
the gelsemic acid; and the residue rendered alkaline, and 
extracted by ether and chloroform in the usual manner, to 
procure the gelsemin. Wormley succeeded in recovering 
both of these principles from the stomach of a woman who 
was poisoned by three tablespoonfuls of the fluid extract, 
several months after death ; and likewise from the tissues 
and blood of animals poisoned with the extract. 

Poisonous Mushrooms. — Many varieties of fungi are 
edible, but a few possess noxious and even fatal properties. 
It is not always possible to distinguish between the two 
classes, inasmuch as climate, season, and idiosyncrasy may 
occasion the difference. The poisonous principles of some 
fungi appear to be volatile, since boiling renders them 
innocuous. 

Symptoms. — The effects of poisonous mushrooms on man 
are usually those of the narcotic irritants, causing violent 
vomiting, purging, abdominal pain, thirst, anxiety, cold 
sweats, together with giddiness, dimness of vision, tremb- 
ling, dilated pupils, delirium, illusions, stupor, coma, con- 
vulsions, and death. 

It is stated that the very same fungi have acted on some 
members of a family as vomitants only, and on others as 
narcotics. 

Generally, the symptoms show themselves within one 
hour — especially the narcotic symptoms. Orfila relates the 



LILY OF THE VALLEY. 53 5 

following interesting case of poisoning of a family of six 
persons by the Amanita citrina. The wife, servant, and one 
of the children had vomiting, followed by deep stupor, but 
they recovered. The husband had violent cholera ; he re- 
covered also. The two other children became profoundly 
lethargic and comatose ; emetics had no effect, and death 
ensued. The individuals who recovered were not con- 
pletely well until three weeks after the fatal repast. 

Morbid Appearances. — These are imperfectly described ; 
they indicate a great tendency to rapid putrefaction, lividity 
of the body, fluidity of the blood, absence of cadaveric 
rigidity, numerous ecchymoses in the serous membranes 
and parenchymatous organs, signs of violent and even 
gangrenous inflammation of the stomach, and conges- 
tion of the vessels of the brain, with decomposition of the 
tissues. 

The chief interest connected with this subject is the fact 
that the symptoms occasioned by eating poisonous fungi 
might easily be attributed to poisoning — homicidal or 
otherwise. A microscopic examination of the contents of 
the stomach and bowels will usually reveal the botanical 
character of the fragments of the fungi, if the poisoning has 
been due to them. 

Lily of the Valley {Convallaria majalus). — Huenerfauth 
reported two instances in which he suffered serious symp- 
toms, after rectal injections of glycerin. He had mental 
disturbances, palpitation of the heart, irregular, rather weak 
pulse as high as 140 per minute, dyspnea, rigors and cold 
extremities. Active vomiting followed the ingestion of a 
cup of strong tea, and the more severe symptoms subsided 
after two hours. By the next morning the condition was 



53^ TOXICOLOGY. 

normal except slight prostration. In the second instance, 
frequent and abundant urination was the most noticeable 
condition. An analysis of the glycerin showed that it was 
free from arsenic, but was flavored with extract of Lily of 
the Valley, and the case was probably one of poisoning by 
this substance. 

Camphor. — Dr. C. J. Robertson-Milne, of Calcutta, 
has reported the following case. A woman, aged 39, drank 
a quantity of gin and beer during the day and at a late 
hour in the evening swallowed about 2 ounces of camphor 
liniment; an empty bottle and a paper stating that the 
camphor liniment had been swallowed were found beside 
her. 

On admission at 11 P. M. she was semi-conscious and 
extremely restless, making constant purposeless movements 
of her arms and legs. Face flushed. Skin warm. Pupils 
widely dilated. Conjunctivae insensible. Breathing some- 
what labored, 34. Pulse full and strong, 84. The stomach 
washed out with difficulty, owing to the inflammatory con- 
dition of pharynx. A quantity of brown grumous matter, 
food, etc., smelling strongly of camphor, was evacuated. 
The patient fell into a deep sleep, awoke six hours later 
and vomited several times. She had completely recovered 
about midday and was taken home. 

CANTHARIDES— POISONOUS ANIMAL FOOD— SAUSAGE 
POISON— TRICHINOSIS— CHEESE POISON— POISON- 
OUS FISH— PUTRESCENT FOOD— POISONED 
FLESH. 

Cantharides. — The Cantharis vesicatoria, or Spanish fly, 
is much used in medicine, both externally as a vesicant, 
and also internally. In large doses it acts as a powerful 



CANTHARIDES — POISONOUS ANIMAL FOOD. 53/ 

local irritant to the alimentary canal, and also to the genito- 
urinary organs. It is often used as an abortive, and has 
not infrequently produced fatal effects when employed for 
this purpose. It owes its active properties to a crystalline 
principle named cantharidin, which exists in the proportion 
of about one grain to half an ounce of the powder. 

Symptoms, — A burning sensation in the mouth and throat, 
with constriction and difficulty of swallowing ; violent pain 
in the abdomen, increased by pressure ; nausea, and vomit- 
ing of a bloody mucus and shreds of membrane, along with 
great thirst and dryness of the fauces. Soon the character- 
istic impression on the genito-urinary organs displays itself 
in a dull, heavy pain in the loins, an urgent and incessant 
desire to urinate, which is attended with great pain and the 
voiding of merely a few drops of bloody urine, accom- 
panied by tenesmus. Priapism frequently occurs in males, 
and swelling and heat of the labia in women, together with 
abortion, at times, in pregnant females. Purging generally 
supervenes, the stools being bloody and mucous, and 
accompanied by tenesmus. Sometimes there is profuse 
salivation, and in fatal cases, faintness, giddiness, and con- 
vulsions. If the substance has been taken in the form of 
powder, the characteristic shining green particles may gen- 
erally be recognized in the discharges from the stomach 
and bowels. If the tincture has been taken, the above 
symptoms come on more rapidly. 

All the above symptoms have been produced by the ex- 
ternal application of cantharides. 

Fatal Dose. — Twenty-four grains of the powder and an 
ounce of the tincture have caused death. 

Treatment. — Speedy evacuation by emetics and cathar- 
tics (castor oil) ; opium, and stimulants. 



53^ TOXICOLOGY. 

Post-mortem Appearances. — Intense inflammation of the 
mucous membrane of the alimentary canal, from the mouth 
downward, also of the ureters^, kidneys, and bladder. Con- 
gestion of the brain has been observed. The peculiar shin- 
ing green particles can generally be distinguished in the 
stomach and bowels. But if the tincture has been swallowed, 
it will be necessary to procure the extraction of cantharidin 
from the organic matters. 

Analytic Methods. — The suspected materials should be 
dried, and digested in successive portions of ether, until 
exhausted ; this will dissolve out the cantharidin. The 
ethereal solution is to be evaporated until nearly dry, and 
the residue should be spread on oiled silk, and a portion 
applied to the lips, or on the thin portion of the skin of the 
arm, when the resulting vesication would denote the pres- 
ence of cantharides. 

Poisonous Animal Food. — It occasionally happens that 
animal food, such as sausages, cheese, fish, muscles, etc., 
produce poisonous symptoms, either owing to some idio- 
syncrasy on the part of those who have partaken of them, 
or depending upon some noxious agent connected with the 
food itself, either introduced from without or spontaneously 
generated within. 

Such cases are often attended with symptoms of a violent 
character, which naturally suggest poisoning, and they then 
become the subjects of medico-legal examination. 

Sausage Poison. — Physicians and physiologists are dis- 
posed to attribute some instances of so-called sausage poi- 
soning to the presence of animal parasites which live for 
some time after the animal is slaughtered, but are killed by 
thorough cooking. When meat containing the living ani- 



POISONOUS FISH. 539 

mals is eaten, these rapidly multiply in the stomach and 
intestines, and penetrate the muscular coat of these viscera, 
and spread rapidly through the muscles, generally, and pro- 
duce the irritation of the bowels and the subsequent loss 
of muscular power characteristic of some of these cases. 
In the other cases the noxious agent is undoubtedly pto- 
mains generated in the decomposing meat. It is more likely 
to occur in uncured sausage. 

It may readily happen that the symptoms thus occasioned 
might be attributed to poisoning by one of the mineral irri- 
tants. A careful microscopic and chemical examination of 
the suspected food, or of a fragment of a muscle of either 
a living or dead subject, will be necessary, and will often 
reveal the true source of the disorder. 

The symptoms of Cheese Poisoning are very similar to 
those of ordinary irritant poisoning. An occasional cause of 
poisonous action of cheese has been revealed by the dis- 
covery, by Vaughan, of a ptomain to which he has given 
the name of tyrotoxicon. Instances of cheese poisoning are 
more common in Germany than in this country. 

Poisonous Fish. — In certain individuals, probably 
through idiosyncrasy, many kinds of fish act poisonously — 
/. e., they excite severe gastro-intestinal symptoms, resemb- 
ling cholera morbus. In many cases some chemical change 
in the food itself has taken place. 

Mussels, which are quite extensively used in Europe 
as food, occasionally produce most violent and alarming 
symptoms, the exact cause of which is not known. 

These symptoms are not of a uniform character. Some- 
times they are those of a simple irritant, such as nausea, 
vomiting, purging, pain in the abdomen, cramps, small and 
frequent pulse. The fatal cases disclose on post-mortem 



540 TOXICOLOGY. 

examination evident signs of inflammation. In other in- 
stances the gastro-enteric disturbance has been slight, 
while the nervous symptoms are well marked, such as 
delirium, insensibility, loss of muscular power, and coma, 
with dyspnea and convulsions. Again, the most conspic- 
uous symptoms have been a peculiar eruption resembling 
urticaria, along with severe asthma. The symptoms usually 
do not appear under the lapse of twenty-four hours ; but 
there are cases where they come on very much earlier. In 
fatal cases the autopsy usually reveals nothing that will 
satisfactorily account for the result. 

The following cases are interesting in this connection : 
Three persons, father, mother and an ii -year-old child, ate 
respectively, 2, 2 and 3 sardines preserved in oil. The child 
was taken sick the next day, with vomiting, colic, diarrhea 
and dizziness. Later, disturbance of vision, unsteadiness of 
gait and giddiness without headache occurred, also loss of 
consciousness while waking. Sleep was not quiet ; the child 
became aphonic and had cramp of the larynx and difficulty 
in swallowing, but no fever. The cramp increased to a 
general convulsive movement. On the second day the face 
became pale, the pulse weak, and fainting fits occurred, fol- 
lowed by strong convulsive seizures and death. The adults 
were taken sick on the second day. The mother had diffi- 
culty in swallowing, disturbed vision and sensations of 
suffocation. She foamed at the mouth and lost speech. 
Vision was affected but there was no pupillary irregularity. 
Vomiting occurred with laryngeal cramp, formication and 
pain in the limbs. Death took place early. The father, after 
similar symptoms, developed general convulsions, then coma 
and profuse sweating followed by death. The autopsy 
showed high congestion of the mucous membrane of the 



POISONED MEAT. 54 1 

stomach and upper intestine, with hemorrhage and ecchy- 
mosis, congestion of the pancreas, Hver, spleen and par- 
ticularly the kidneys. The heart was normal, contracted on 
the left side and filled with blood on the right. The brain 
membranes were edematous. Bacteriologic examination of 
the blood showed a bacillus, which was pathological to ani- 
mals but not intensely so. It should be differentiated from 
the ordinary bacilli of meat poisonings and was regarded as 
a form of the colon bacillus which soon lost its virulence. 
A sardine remaining from the box was mouldy and emitted 
a putrid odor. Neither metallic impurities nor ptomains 
were found. Other boxes of the same lot were tested with 
negative results. 

Shell-fish taken from waters near cities, where sewage 
contamination is present, are apt to convey typhoid fever. 
Oysters are especially important in this respect but the 
question is one of hygiene rather than toxicology. 

Putrescent or Decayed Meat often produces gastro- 
enteric symptoms similar to those described above, but 
they may also be of a typhoid character, or resembling true 
blood-poisoning. The game that has been kept long enough 
to delight the taste of the epicure has produced a severe 
cholera morbus in persons not accustomed to its use. 

Putrid animal matter injected into the blood vessels 
proves quickly fatal. Dissecting wounds thus may pro- 
duce alarming symptoms, which may terminate in death. 

Poisoned Meat. — The flesh of an animal or bird which 
has become poisoned by arsenic, strychnin, or some other 
deleterious substance may become the cause of poisoning 
to man. Thus, the common pheasant of this country 
{Tetrao umhellus), which has fed upon the leaves and buds 



542 TOXICOLOGY. 

of the kalmia (laurel), has proved poisonous to persons 
who have eaten the birds. It is known that the milk of 
cows and goats that have fed upon the Datura stramonium 
may prove poisonous to those partaking of it. In one case 
of alleged poisoning by belladonna the defense was that the 
family had eaten a rabbit pie, and that the animal had fed 
upon the leaves of the belladonna plant, so that, without 
being affected injuriously itself, it had conveyed the poison 
to those who had partaken of it. Nevertheless, many cases 
of poisoning by animal food which have been supposed to 
be due to the introduction of some poison into the animal 
before death, have really been due to changes in the dead 
flesh through the action of microbes. In some cases it has 
appeared that the very earliest stages of putrefaction pro- 
duce more virulent action than the later and more offensive 
conditions. 

CLASS II.— NEUROTIC POISONS. 

The second division of Poisons embraces those whose 
effects are displayed chiefly on the great nervous centers — 
the brain and spinal marrow. Their symptoms are drowsi- 
ness, headache, giddiness, stupor, delirium, convulsions, and 
paralysis. They produce little or no irritation or inflam- 
mation on the mucous membrane of the alimentary canal. 
Their post-m^ortem conditions are not very distinctly marked, 
consisting of more or less fulness of the cerebral vessels ; 
rarely effusion of serum ; more rarely still, effusion of blood 
in the brain. It is impossible to diagnose a case of neurotic 
poisoning by these lesions exclusively. 



OPIUM — SYMPTOMS. 543 

OPIUM AND ITS PREPARATIONS. 

Opium and its preparations give rise to a large propor- 
tion of poisoning cases, both in this country and Great 
Britain. According to the statistics furnished by Blyth, 
over forty per cent, of all the cases of poisoning in England 
between the years 1876-80 were due to opium ; and these 
amounted to 393 males and 250 females — total, 643. Out 
of this whole number, there were but two cases of homicide 
(infants) ; 22.4 per cent, of the female cases and 30.5 of the 
male were suicidal. This is a far higher percentage than 
that found in any other European country, or in the United 
States. 

Opium is the dried juice of the unripe capsules of the 
poppy (Papaz'er somniferum). It has a complex composi- 
tion, containing numerous alkaloids, and also one or two 
acid principles. Among the alkaloids are morphin, narco- 
tin, codein, narcein, thebain, and papaverin. Meconic acid 
is the only important acid. In a medico-legal view, the 
only important bodies are morphin and meconic acid, since, 
in an analysis for the detection of opium in a case of sus- 
pected poisoning, the investigation is narrowed down to the 
discovery and identification of these two substances. 

It should be remembered that different specimens of 
opium differ in the contained amount of morphin. The U. 
S. Pharmacopeia requires that opium should contain, when 
dried, about twelve and a half per cent, of morphin. The 
tincture {laudanum) of the shops is far from being of a uni- 
form strength, owing to the variation in the amount of the 
active principle in the opium, and also to fraudulent dilution. 
Laudanum contains about six grains of opium to the fluid- 
drachm, which is equivalent to one grain to twenty drops. 



544 TOXICOLOGY. 

The Acetum Opii of the old pharmacopeia is about double 
the strength of laudanum. It was made to imitate the old 
black drop, but is not quite so strong. Wine of opium 
(Sydenham's laudanum) is about the strength of laudanum. 

Numerous cases of poisoning of children by "soothing 
syrups" are constantly occurring in large cities. These 
preparations are not of uniform composition, but opium or 
morphin generally exist in them. 

Symptoms. — These vary according to the size of the dose. 
A large, but not fatal, dose occasions, at first, general ex- 
citement of the system, as evinced by increased fulness and 
frequency of the pulse, flushed face, brilliancy of the eyes, 
and increased activity of the brain. This is soon followed 
by calm repose, which in turn gives place to profound sleep. 
In proportion as the amount of opium is increased, the first 
period of excitement is shortened, the more characteristic 
soporific effects manifesting themselves sooner. In such a 
case there will be giddiness and drowsiness, rapidly passing 
into profound sleep or stupor, from which it will be difficult 
to arouse the patient ; this stupor gradually ends in coma. 
The pupils are contracted. As first, the pulse is full and 
slow ; subsequently it becomes weak. The respiration is 
generally slow and stertorous ; the skin warm, and the face 
flushed. As the case advances, the countenance becomes 
pale, the lips livid, the skin cold and clammy, the respira- 
tion very slow — we have noticed it reduced down to five or 
six in a minute ; the muscles are relaxed ; convulsions 
sometimes occur just before death, but these are more com- 
mon in children than in adults. Sometimes there is vomit- 
ing, which is to be regarded as a hopeful sign ; and occa- 
sionally also there may be purging. At times the skin is 
bathed in a profuse perspiration. 



OPIUM — FATAL DOSE. 545 

Certain variations in the above symptoms should be 
noticed. The pupils are usually strongly contracted ; toward 
the termination of the case they may sometimes be dilated. 
Occasionally one pupil may be contracted and the other 
dilated. The contracted state of the pupils is usually re- 
garded as a diagnostic sign of opium-poisoning ; but Dr. 
Wilks has shown that this same condition of the eyes occurs 
in apoplexy of the pons varolii, and that two cases of this 
latter disease were mistaken for opium-poisoning. The 
sanie contraction of the pupil occurs also in uremic poison- 
ing, in the course of Bright's disease. 

First Appearance of Symptoms. — This will depend on 
the size of the dose, the form of administration, and the con- 
dition of the stomach at the time. As a rule, the symptoms 
usually commence within an hour after swallowing the 
poison. But if taken in the liquid form and in full quan- 
tity, they may manifest themselves in a few minutes. We 
have often seen full narcosis produced in five to ten minutes 
by the subcutaneous injection of a quarter of a grain of 
morphin. On the other hand, cases are reported where the 
symptoms were delayed, even after swallowing very large 
doses, for many hours. Sometimes a partial remission of the 
symptoms occurs, and the patient gives hopes of recovery ; 
but they return again only to terminate in death. There 
seems reason to believe that alcohol tends to postpone the 
development of the usual symptoms of opium. 

Fatal Period. — The average duration of a fatal case is 
from seven to twelve hours. Cases are reported where the 
symptoms appeared in twenty-five minutes, and death in 
three quarters of an hour ; whilst, on the other hand, death 
has been, in some instances, delayed for twenty- five to forty- 
eight hours. 
47 



546 TOXICOLOGY. 

Fatal Dose. — Four or five grains may be regarded as the 
minimum fatal dose for an adult. Children are particularly 
susceptible to the action of this drug ; in very young infants, 
fatal effects have resulted from taking two or three drops 
of laudanum. An infant may be narcotized by the milk of 
a nurse who has taken opium. 

On the other hand, recoveries constantly take place from 
very large doses — even up to several ounces. It is notori- 
ous that the human system soon acquires a remarkable 
tolerance for this narcotic by habit. De Quincey thus 
brought himself to the daily use of nine ounces of lauda- 
num, which is equivalent to about three hundred and sixty 
grains of solid opium. 

Occasional instances of idiosyncrasy occur in which the 
susceptibility to the narcotic influence of opium is greatly 
augmented ; and also, on the other hand, where there seems 
to be a natural tolerance for the drug. As regards the 
opium habit, there can be no doubt of its ultimate deleteri- 
ous effects upon the human system. 

The external application of opium, especially to an 
abraded surface, may prove highly dangerous and even 
fatal especially in the case of infants. Christison relates an 
instance where a laudanum poultice, applied over the abdo- 
men of an infant to relieve pain, produced fatal narcotism 
in some hours ; and where at the autopsy, a strong odor of 
opium was exhaled from the body, showing how completely 
the poison had been absorbed. 

Post-mortem Appearances. — These are neither certain nor 
characteristic. There is usually some fulness of the vessels 
of the brain ; occasionally, extravasation of serum into the 
ventricles, very rarely of blood. Sometimes there is con- 
gestion of the lungs and other vascular organs. The blood 



OPIUM — TREATMENT. 54/ 

is apt to be fluid. The stomach and bowels may be per- 
fectly natural in appearance. The odor of opium may be 
observed in opening the body. It is hence impossible to 
diagnosticate a case of opium-poisoning from the post- 
mortem appearance exclusively. 

Treatment. — Remove the poison from the stomach as 
speedily as possible by the stomach-pump, or by a prompt 
emetic, as zinc sulphate or mustard water. In case of 
inability to swallow, it has been recommended to inject 
hypodermically a solution of -^-^ of a grain of apomorphin, 
which usually produces prompt emesis. Moderate exercise 
by rubbing or forced walking are of value in maintaining 
active respirations, but the violent treatment formerly in 
vogue is not now approved. Strong coffee has some anti- 
dotal power. It appears that organic poisons, especially 
morphin, tend to be excreted into the stomach from the 
blood, so that chemical antidotes are applicable even when 
the poison has not been taken by the mouth. 

Potassium permanganate has been strongly recommended 
by Dr. Moor. In poisoning by morphine or its salts he 
advises the administration of from ten to fifteen grains dis- 
solved in six to eight ounces of water, and this dose re- 
peated every thirty minutes until three or four doses have 
been taken. When laudanum has been taken, it is advis- 
able to add a few drops of dilute sulphuric acid to the 
antidote. 

Physiologic Antidotes. — Atropin was long regarded as 
specifically applicable, but the trend of opinion at the 
present day is against this view. Reichert, who studied the 
physiologic relations of the two drugs carefully, regards 
atropin as applicable only in the second stage of morphin 
poisoning and then only in limited use. He suggests that 



54^ TOXICOLOGY. 

an antidote may be found in adrenalin, a substance extracted 
from the suprarenal capsules, but this view has not yet re- 
ceived clinical confirmation. 

In a case recently (1905) reported cocain hydrochlorid 
one fourth grain hypodermically was used with success. 
This dose might be once repeated. 

Morphin. — When pure, morphin is in the form of color- 
less bitter rhombic crystals, slightly soluble in water, sol- 
uble in alcohol, especially when hot, almost insoluble in 
chloroform and pure ether, very soluble in acetic ether and 
amyl alcohol. It is slightly alkaline, forming salts with 
acids. Its solutions, in common with the other alkaloids, 
are precipitated by tannic acid. Its salts are soluble in 
water and diluted alcohol, but insoluble in chloroform, ether, 
amylic alcohol, and pure acetic ether. 

The symptoms produced by morphin resemble those of 
opium, except that they ordinarily manifest themselves 
rather earlier and possibly tend to produce convulsions 
rather more frequently than opium. Occasionally these 
convulsions have been of a tetanic character, suggesting 
the presence of strychnin. 

Fatal Dose. — One grain has, on several occasions, pro- 
duced death. Dr. Reese saw a case in which three quar- 
ters of a grain administered hypodermically proved fatal to 
a man within twenty-four hours. Still smaller doses thus 
administered have produced fatal effects. On the other 
hand (as in the case of opium), enormous doses have been 
swallowed with impunity. Norris reports a case in which 
a druggist took, with suicidal intent, seventy-five grains of 
morphin sulphate. No marked symptoms appeared for an 
hour and a half. He then became unconscious, but under 



MORPHIN. 549 

active treatment, including extract of belladonna, he en- 
tirely recovered on the second day after the occurrence. 
Other cases have since been reported where still larger 
quantities (one of 120 grains) were taken, where the patient 
recovered. 

The external application of morphin to an abraded surface 
has been attended with fatal effects. 

There are no characteristic post-mortem lesions produced 
by morphin. The general appearances are similar to those 
caused by opium. 

Analytic Methods. — Opium is identified by its sensible 
properties and by its physiological action on animals. The 
only mode of identifying it chemically is by detecting the 
presence of its two important constituents, morphin and 
meconic acid, or some of its other principles. The two 
former are chiefly relied on. 

Detection of Morphin. — I. In the solid state. — (i) 
Strong nitric acid dissolves it with effervescence, evolving 
red fumes, and gives an orange-red solution, slowly fading 
to yellow. Nitric acid produces a deep-red color with 
brucin, which, on the addition of stannous chlorid, changes 
to a bright purple ; whereas no change is produced in the 
case of morphin. (2) Strong sulphuric acid dissolves it 
without change of color ; if now a crystal of potassium 
dichromate be added, it acquires a green color. (3) Ferric 
chlorid imparts a deep-blue color to it, changing to green 
if added in excess. In this test free acid must not be 
present. (4) Iodic acid, added to a fragment of morphin, 
along with freshly made starch, produces the characteristic 
blue color from the liberated iodin. This reaction, how- 
ever, occurs with other substances. According to Otto, if 
a fragment of morphin or one of its salts be dissolved in 



550 TOXICOLOGY. 

strong sulphuric acid, by the aid of heat, and on cooHng a 
little water added, with a crystal of potassium chromate, a 
deep mahogany-brown color is produced. 

11. In the liquid state. — (i) Nitric acid, in excess, gives 
an orange-red color, which becomes light yellow on boil- 
ing. (2) Ferric chlorid acts as on solid morphin. (3) Iodic 
acid in carbon disulphid, added to a solution of morphin, 
causes a pink or red precipitate, consisting of iodin, in the 
disulphid. (4) A solution freshly prepared by dissolving 
five milligrams of ammonium molybdate in one c.c. of sul- 
phuric acid, gives with morphin a purple or crimson, which 
quickly passes through several shades, and after a while 
becomes deep blue. 

Several other tests are given in analytic manuals, but 
they are of less value than those enumerated. 

Meconic Acid. — Since this acid is peculiar to opium, its 
detection affords proof of the presence of that substance. 
In its pure state, it occurs in the form of colorless crystals, 
tolerably soluble in water, more so in alcohol. 

Tests. — (i) Ferric chlorid imparts to either the solid or 
solution a blood-red color, which is not removed by a solu- 
tion of mercuric chlorid. The only fallacy likely to occur 
is from the presence of a thiocyanate, which yields a similar 
color with the iron salt. Thiocyanates occur in the saliva ; 
but the red color thus given with ferric chlorid is instantly 
discharged by mercuric chlorid. Strong acetic acid, or its 
salts, likewise give a red color with the ferric salts ; and 
this color, moreover, is not removed by mercuric chlorid, 
but if the acetate be previously boiled with dilute sulphuric 
acid it gives no color with the iron salt. (2) Lead ace- 
tate yields a yellowish-white precipitate of lead meconate. 



MECONIC ACID EXAMINATION. 551 

(3) Barium chlorid yields a white crystalline deposit of a 
peculiar form. (4) Silver nitrate gives a yellowish-white 
precipitate, which becomes red on adding ferric chlorid. 

Toxicologic Examination. — Sometimes, on opening the 
stomach, the strong odor of opium is readily detected, and 
also in the matters vomited. The discovery of this poison 
in the stomach is often unsuccessful, owing, probably, to its 
decomposition and absorption in the body. This is espe- 
cially true in the case of infants, in whom a very few drops 
have sufficed to destroy life. The highest authorities unite 
in declaring that the analyst will fail to discover the poison 
in the stomach after death, in the majority of the cases. It 
is much more likely to be found in the vomit. 

The stomach should be cut up in small fragments, adding 
water with a little alcohol, and acidulating with pure acetic 
or tartaric acid, and the whole exposed to a gentle heat for 
about one hour. After cooling, it should be strained 
through muslin, the solid residue washed with strong alco- 
hol and pressed, and the washings added to the first liquid. 
The liquid should then be evaporated over a water-bath to 
a small volume, and when cooled filtered through paper. 
To the clear filtrate, lead acetate is to be added in excess, 
which throws down lead meconate. The morphin remains 
in the solution as an acetate or tartrate. These are to be 
separated from one another by filtration, and the solid 
matter washed with water. 

(a) The solid portion, lead meconate, is to be diffused 
through water, and treated with hydrogen sulphid gas, 
which precipitates lead sulphid, and leaves meconic acid in 
solution ; the liquid is filtered, the precipitate washed, and 
the filtrate and washings concentrated on a steam-bath. A 
trial test on a small portion of this liquid by ferric chlorid 



552 TOXICOLOGY. 

may be made ; if a deep-red color is imparted, meconic acid 
may be suspected ; to the remainder of the hquid the other 
tests may now be appHed. If present in sufficient quantity, 
meconic acid will crystallize out on evaporation of the 
liquid. If the quantity, however, be minute, the liquid 
should be carefully concentrated to a small volume and the 
characteristic tests employed. 

(b) The filtrate from the lead meconate, containing the 
morphin in the form of acetate, together with the excess of 
lead acetate, is to be treated with hydrogen sulphid in order 
to remove the lead ; then filtered and the filtrate concen- 
trated by gentle heat to dryness. The residue is then 
treated with a few drops of warm distilled water and a por- 
tion of it examined for morphin by the nitric acid, iron, and 
iodic acid tests ; the remaining liquid should then be made 
alkaline by pure potassium carbonate (diluting, if necessary, 
with water) ; it is allowed to stand for half an hour, and is 
then shaken up with an excess of absolute ether, which 
will take up the impurities, leaving the morphin unaffected. 
The ethereal solution is removed by means of a pipette and 
reserved for future examination, if necessary. The remain- 
ing alkaline solution is now to be thoroughly shaken with 
two or three times its volume of either a mixture of two 
parts of absolute ether and one of alcohol (as recommended 
by Wormley), or of two or three volumes of hot amylic 
alcohol, or of a similar bulk of acetic ether. By either of 
these processes the morphin is taken up by the solvent, 
which floats upon the top of the mixture, and which may 
be removed by a pipette and allowed to evaporate spon- 
taneously on watch-glasses. Ordinarily the morphin thus 
recovered is amorphous, and may require re-solution in hot 
alcohol and to be crystallized therefrom by evaporation. 



MECONIC ACID. 5 53 

In cases of poisoning by morphin alone (or one of its 
salts) the above process may be employed, omitting the 
treatment with lead acetate, inasmuch as no meconic acid 
is present. 

Detection in the Tissues and Blood. — There is generally a 
failure to detect this poison in the organs and tissues, or in 
the blood. Yet, on the other hand, cases are reported 
where it has been discovered in the body several months 
after death ; by Stas thirteen months after. There is some 
doubt about the detection of the opium principles in the 
urine, inasmuch as the results alleged to have been pro- 
duced by certain reagents and supposed to indicate the 
presence of morphin or meconic acid have since been 
shown to be due to substances existing normally in the 
urine. 

The toxicologist should be cautioned against a too hasty 
conclusion as to the presence of opium, or its alkaloid, upon 
color tests alone. Orfila relates that Ruspini and Cogrossi 
found that decoction of calf's intestines, although no mor- 
phin was present, acted upon iodic acid and starch like that 
alkaloid. In another case morphin was pronounced to be 
present in the urine by reason of the action of the extract 
of this secretion on the iodic acid and urates. In the em- 
ployment of these extraction processes it must be remem- 
bered that commercial ether, alcohol, benzene, etc., may 
contain small amounts of impurities giving reactions which 
simulate various alkaloids. 

Inasmuch as the symptoms of opium poisoning strongly 
resemble those of apoplexy, it might readily happen that 
a case of the latter disease, attended with suspicious sur- 
roundings, might be mistaken for the former, and the con- 
tents of the stomach might even possibly reveal a red color 
48 



554 TOXICOLOGY. 

when treated with nitric acid. If no morphin (nor meconic 
acid) was actually separated, the examiner would not be 
authorized to pronounce upon the presence of this poison 
simply from the single reaction above mentioned. Taylor 
cites an instructive illustration of this hasty conclusion, in 
which a chemist made oath of the discovery of " distinct 
traces of morphin " in the stomach ; whereas, in reality, no 
morphin had been taken at all (as was proved by an analysis 
of the medicine swallowed by the deceased) ; but the death 
was due entirely to natural causes. 

ALCOHOL. 

The poisonous effects of Alcohol may be either acute or 
chronic. The former are witnessed in those cases in which 
a large quantity of spirits is taken at a single draught. The 
latter are illustrated in the common dramdrinkers, and by 
a train of symptoms with which we are, unfortunately, too 
familiar. The former only will be discussed here. 

Symptoms of Acute Poisoning. — These come on usually in 
a few minutes after the ingestion of the poison, if the amount 
is large. They are, first, giddiness, confusion of ideas, un- 
steadiness of gait, incoherent talking, followed by stupor 
and coma. The features have a vacant, ghastly expression, 
or they may be suffused or bloated; the lips are livid; the 
pupils usually dilated and fixed ; the conjunctivae are red ; 
an alcoholic exhalation from the breath is perceived; con- 
vulsive movements of the limbs ; respiration, at first sterto- 
rous, becomes more and more difficult ; a bloody froth may 
appear on the lips ; involuntary evacuations occur, and 
death may ensue in half an hour, or even earlier, after the 
fatal drink. In other instances the person may apparently 
recover from the first effects and then suddenly become 



ALCOHOL ANALYTIC METHODS. 555 

insensible and die in convulsions. If free vomiting occurs, 
followed by a prolonged sleep, recovery is apt to take 
place. The sensibility of the pupil to light may also be 
regarded as a favorable symptom. 

The rapidity with which the symptoms show themselves 
will depend upon the previous habit of the individual and 
the strength and quantity of the spirit taken. The very 
large quantities seem to destroy life by shock. 

Acute alcoholism may be mistaken for opium-poisoning 
and concussion of the brain. Usually the odor of the 
breath is sufficient to reveal the case, also the dilated pupil ; 
but this condition of the eye is not invariably present. In 
concussion there are often marks of injury in the head ; the 
face is pale and cold ; there is also an absence of the alco- 
holic odor. 

Post-mortefn Appearances. — There is generally a remark- 
able absence of putrefaction in the body. The stomach 
exhibits marks of intense congestion in the deep-red color 
of its lining membrane, either diffused or in patches ; more 
or less congestion of the brain and its membranes, with 
serous effusion under the arachnoid and in the ventricles ; 
sometimes there is a true apoplectic extravasation of blood. 
The lungs are almost invariably congested. Usually a 
strong alcoholic odor is perceived from the different tissues 
of the body ; but the organs for which the poisonous fluid 
displays the greatest affinity are the brain and liver. 

Alcohol is very rapidly absorbed into and eliminated 
from the system, so that if the person has survived several 
hours all traces of it may have been removed from the body. 

Treatment. — Immediate evacuation by means of the 
stomach-pump or by an active emetic ; effusion of cold 
water over the head ; a free supply of fresh air ; if there be 



556 TOXICOLOGY. 

asphyxia, galvanism may be tried ; also ammonium hydroxid 
and the liberal use of coffee as a drink. 

Analytic Methods. — If the case has not been too pro- 
tracted, the alcohol may be recovered from the stomach 
and its contents by distillation in a capacious retort on a 
water-bath with a good condensing apparatus. If the 
materials are acid, they should first be neutralized by 
potassium or sodium carbonate. The distillate should be 
mixed with calcium chlorid and re-distilled. The second 
distillate is to be shaken with an excess of potassium car- 
bonate (which absorbs the water) and set aside. The 
stratum of alcohol which rises to the top may then be sep- 
arated by means of a pipette, and submitted to the follow- 
ing tests : ( I ) Its taste is hot and pungent ; its odor is 
characteristic; it burns with a pale-blue flame, leaving no 
carbonaceous residue; if burnt under the mouth of a test- 
tube moistened with lime water, the carbonic acid will pro- 
duce a white film upon the sides of the tube. (3) It dis- 
solves camphor. (4) On adding a solution of potassium 
dichromate and hydrochloric acid the peculiar odor of alde- 
hyde is developed, along with the green color of chromic 
chlorid. In performing this test Taylor recommends con- 
ducting the vapor from the retort in which the distillation 
is going on into a glass tube containing a few fibers of 
asbestos moistened with a mixture of a strong solution of 
the dichromate and sulphuric acid (used in this case instead 
of hydrochloric acid), when the merest trace of alcohol 
vapor will be sufficient to impart the green coloration. 

Both ether and wood spirit will produce this last effect 
and likewise yield most of the results of alcohol. Ether 
may be distinguished by its odor and by the yellow color 
of its flame ; also by its smoky deposit on porcelain. Wood 



ALCOHOL — SYMPTOMS. 557 

Spirit may be recognized by its peculiar color and by its 
smoky flame on burning. 

In the Tissues. — The proof of the absorption of alcohol is 
aflforded in its detection in the blood, urine, and different 
tissues of the body. If there is a failure to discover it in 
the stomach it should be looked for in the 'brain and liver. 
Buchheim has devised an exceedingly delicate process for 
detecting it in small quantities in the blood and tissues, 
based upon the conversion of the vapor of alcohol into 
aldehyde and acetic acid when passed over platinum-black. 
As much as possible of the material, neutralized first by 
potassium carbonate, should be distilled from a capacious 
retort on a water-bath. The neck of the retort should be 
slightly inclined, and be wide enough to hold a platinum 
tray about two inches long and half an inch wide contain- 
ing the platinum-black. Hanging over each end of the 
tray is placed a slip of moistened litmus paper and touching 
the platinum-black. The tray is now pushed toward the 
body of the retort. As soon as there is any escape of 
alcoholic vapor by the distillation it will be manifested by 
the reddening of the litmus paper at the farthest end of the 
tray, in consequence of the production of acetic acid, while 
the paper nearest the body of the retort will remain blue. If 
no reddening of the paper occurs, no alcohol can be present ; 
if the reddening rapidly occurs, the tray should be removed 
and the vapor should be condensed in the usual way. 

As both ether and wood spirit produce a similar effect 
on platinum-black, this process offers no advantage over 
the chromic acid process above described, except when 
putrefaction has taken place, in which case the hydrogen 
sulphid evolved might reduce the chromate, but not affect 
the platinum-black. 



558 TOXICOLOGY. 

A few drops of a liquid containing alcohol added cau- 
tiously to a solution of one part of molybdic anhydrid in 
ten of strong sulphuric acid gives, on gi^ntle warming, a 
blue color. 

To ten c.c. of a clear liquid suspected to contain alcohol 
add five drops of a ten per cent, solution of sodium hydroxid 
and warm to about iio° F. Then add drop by drop with 
shaking a saturated solution of iodin in potassium iodid 
until the liquid becomes permanently yellowish-brown. If 
now the liquid be decolorized by the further slow addition 
of sodium hydroxid, iodoform will be produced if alcohol 
be present, and can be identified by its color and crystalline 
form. Unfortunately this reaction is caused by many other 
bodies, especially acetone, but not by chloroform, chloral, 
glycerol, or ether, nor by acetic^ formic, or oxalic acids. 

Methyl Alcohol. — A highly impure form of methyl al- 
cohol obtained from the products of distillation of wood and 
commonly called wood-spirit, has been used for a long while 
in industrial work. Its strong unpleasant odor and taste 
have led to its use in England for the purpose of rendering 
alcohol unfit for drinking purposes, the mixture, called 
methylated spirit, being free from tax. The preparation of 
an absolutely pure methyl alcohol is difficult and hence 
very little is known as to the therapeutic effects of it. Dr. 
Benjamin Ward Richardson published some statements 
based on his own experiments, in which he claimed that it 
is lighter and more transient as a stimulant than common 
alcohol, and he suggested that it might have therapeutic 
value as a diffusible stimulant. Dujardin-Beaumetz, in an 
article presented to the French Academy in 1876, stated 
that pure methyl alcohol is more toxic than ethyl alcohol 
and, as might be expected, the toxic action is still higher in 



METHYL ALCOHOL. 559 

the commercial impure forms. Unfortunately, he does not 
give any information as to how the pure alcohol was ob- 
tained. 

Within the last few years a purified methyl alcohol has 
been sold largely under the trade name "Columbian spirit." 
It is supposed to be nearly pure and has been used a great 
deal, often surreptitiously, as a substitute for common alco- 
hol (ethyl alcohol). Numerous instances of sudden and 
serious blindness have been traced to the use of this ma- 
terial, and it seems that it has a special toxic effect, differ- 
ent, or at least far more virulent than the common alcohol. 
This question cannot, however, be decided until it is shown 
that the so-called Columbian spirit is pure methyl alcohol. 
It is not impossible that some empyreumatic product, of 
the creosote type, perhaps, is retained, since all the puri- 
fied methyl alcohol of commerce is made from the crude 
material from wood distillation. 

Less than half an ounce has produced total permanent 
blindness. It is stated that three fluidounces have caused 
fatal poisoning. 

Dr. de Schweinitz reported a case of methyl alcohol am- 
aurosis in which the pathway of entrance was the lungs 
and the cutaneous surface of the hands and forearms. The 
patient, a varnisher and painter by trade, denied that he 
drank wood-alcohol in any form. He had, however, to use 
Columbian spirits, the fumes of which frequently caused 
him to stagger. He was accustomed to wash his hands 
and arms, and sometimes his face, with wood alcohol to re- 
move varnish stains. For two months prior to his blindness 
he had used daily methyl alcohol. For some time he had 
noticed attacks of misty vision, usually coming on at even- 
ing, and lasting fifteen or twenty minutes. 



>56o TOXICOLOGY. 

One morning he had a chill and was unable to continue 
his labor. The chill was accompanied by shooting pains in 
the lower extremities. At midnight of the same day he 
awoke to find that he could not see the gaslight in the room. 
The blindness continued absolute for two weeks. Under 
treatment, pilocarpine sweating, he improved so as to dis- 
tinguish objects, but in three weeks' time vision began to 
fail until he became completely blind. 

The ophthalmoscopic appearance of these cases is optic 
neuritis with exudations into the retina and subsequent 
atrophy. The caliber of the retinal vessels is much dimin- 
ished, and the veins are tortuous, containing very dark 
blood. In the early stages an absolute central scotoma 
and color-blindness are found. The field of vision is con- 
tracted. The lesion may be a primary retrobulbar neuritis, 
or it may depend upon nutritive changes in the ganglion 
cells of the retina. Both retina and optic nerve seem to be 
involved in those cases in man so far studied clinically. 

Formaldehyde. — This is now largely used as an antiseptic 
and disinfectant, generally in the form of the so-called 
" formalin," a forty per cent, solution in water. Formal- 
dehyde is a gas but easily changes to a solid (polymeric) 
designated paraform. The water solution is irritating and 
in large doses will produce inflammation, and an intoxica- 
tion resembling that of alcohol. The antidote to it when 
inhaled is the cautious inhalation of ammonia, which con- 
verts the formaldehyde into a harmless substance. When 
formaldehyde has been swallowed the stomach should be 
washed out thoroughly if possible. 

The following fatal case of formaldehyde poisoning, re- 
ported by Dr. L. A. Levison, of Toledo, Ohio (/. Amer. 



FORMALDEHYDE. 56 1 

M. A.y June 4, 1904), is given in full owing to the common 
use of this substance, and the limited information as yet 
available in reference to its action and treatment. It is as- 
sumed that the " apomorphia " of the report means apomor- 
phin hydrochlorid. 

A man aged 60, a patient at the county hospital, secured 
access to a bottle of commercial formaldehyde (40 per cent.), 
used for disinfecting purposes and swallowed with unknown 
intent, an unknown quantity, estimated at two or three 
ounces. The fact that the patient had been recently released 
from a workhouse sentence and was a long sufiferer from 
a chronic dysenteric condition might lend weight to a sui- 
cidal purpose, which, indeed, was the substance of the coro- 
ner's verdict. 

When first seen, a few minutes after swallowing the 
formaldehyde, the patient was lying in bed, where he had 
been carried after falling to the floor. He was tossing 
around in bed, groaning aloud, evidently suffering intense 
pain. Questions could not be, at least were not, answered. 
The diagnosis was made by the odor of formaldehyde on the 
breath, after eliciting from other patients that he had been 
seen drinking something. Lachrymation was profuse, res- 
piration noisy and labored, rate 30, with loud mucous rales 
from the greatly increased secretion of mucus in the nose, 
throat and mouth. The pulse at first was strong, rate 112, 
but gradually weakened and finally became imperceptible. 
Cyanosis was marked. Unconsciousness soon intervened, 
lasting about ten minutes, from which the patient partially 
recovered. Deep cyanosis and widely dilating pupils pre- 
ceded death. The patient lived in all about twenty minutes 
after first being seen. 

An efifort to pass a stomach tube was unsuccessful, ap- 



562 TOXICOLOGY. 

parently owing to a spasmodic contraction of the esophagus, 
with tightly clenched jaws. The patient could not or would 
not cooperate at all in this effort. Three hypodermatic 
injections of apomorphin hydrochlorid, ^t grain each, were 
without any effect. When the pulse began to fail, resort 
was had to strong stimulation with strychnin and adrenalin 
without apparent effect. 

The examination, 30 hours after death, showed blood 
still fluid, dark brownish-red in color. The stomach con- 
tained several hundred c.c. of fluid, having a strong odor of 
formaldehyde. The mucosa of the lower part of the esoph- 
agus, stomach and first portion of duodenum were dark, 
chocolate brown in color and of the consistency of leather. 
All organs and tissues in contact with the stomach were 
'' hardened " in a similar manner to a depth of about one 
third of an inch. The bronchi contained an excessive amount 
of mucus. 

POISONING BY ETHER, CHLOROFORM, AND CHLORAL 
HYDRATE. 

Ether, often called, erroneously, sulphuric ether, is a 
limpid, colorless liquid, of a peculiar odor, and hot, pungent 
taste ; highly volatile and inflammable ; sp. gr., 0.735 ; boils 
at 95° F. ; burns with a bright-yellow flame, depositing 
carbon on a cold porcelain surface. Sparingly soluble in 
water ; very soluble in alcohol. 

Symptoms. — In large doses it produces much the same 
effects as alcohol. There is usually a short period of de- 
lirious excitement, following by coma and other symptoms 
of narcotism, similar to those caused by alcohol. 

Post-mortem Appearances. — On account of its less solu- 
bility in water, ether is a more powerful local irritant than 



CHLOROFORM — SYMPTOMS. 563 

alcohol. The mucous lining of the stomach and duodenum 
of a dog poisoned with ether were found to be violently 
inflamed, the lungs deeply congested, and the heart full of 
black blood. 

The inhalation of ether, as is well known, produces rapid 
anesthesia. It immediate effect, when inhaled, is the pro- 
duction of a transient excitement ; this is soon followed, 
if the dose be sufficient, by stupor' and insensibility. This 
last condition may be prolonged for a considerable time by 
continuing the inhalation. Occasionally the excitement is 
of a violent character, along with a stubborn resistance to 
the anesthetic influence ; and, again, there may be nausea 
and vomiting. 

Analytic Methods. — Ether is recognized by its odor and 
taste, by its mode of combustion and volatility, and by its 
action on sulphuric acid and potassium dichromate — the 
same as in the case of alcohol. 

From organic mixtures, as, e. g., the contents of the 
stomach, it is to be separated by the same process as that 
described for Alcohol. 

Chloroform. — A colorless, limpid liquid, very volatile, 
giving off a dense vapor; sp. gr., 1.497; boiling point, 
142° F. It has an agreeable characteristic odor, and a 
smart, pungent taste. It is nearly insoluble in water, in 
which it sinks in globules. It is not easily inflammable. It 
is a powerful solvent of many organic substances, the alka- 
loids among others. At a red heat, its vapor is decom- 
posed into chlorin and hydrochloric acid. 

Symptoms. — A large dose produces local irritation in the 
stomach, with, at first, a general stimulation of the whole 
system, soon followed by a decided narcotism, as shown by 



564 TOXICOLOGY. 

insensibility, stupor, convulsions, dilated pupils, flushed 
face, full and oppressed pulse, and frothing at the mouth. 
Cases are reported where the pupils were contracted. 

Taylor reports a case where a boy, aged four years, died 
in about three hours after swallowing one drachm of chlo- 
roform. It has often caused death in quantities of half an 
ounce and upward. 

When taken by inhalation its impression is more speedy 
than that by ether. There is, moreover, an absence of the 
previous excitement attendant on the latter, the patient 
almost immediately passing into insensibility. It appears 
to act as a depressant from the first, and if not properly 
diluted with atmospheric air, it may rapidly produce death. 
In one case, the fatal result took place in one minute after 
breathing only thirty drops in the state of vapor ; and, in 
another instance, only fifteen drops proved fatal in a very 
short time. The immediate cause of death from chloro- 
form vapor, appears to be, in the majority of cases, syn- 
cope, or the cessation of the heart's action ; in others, 
asphyxia. 

Death by the forced inhalation of chloroform was sup- 
posed to have occurred in the case for which H. H. Mud- 
gett, alias H. H. Holmes, was tried, convicted, and executed 
in Philadelphia. The case excited widespread interest on 
account of the number of crimes of various grades of which 
the prisoner was suspected. The crime for which he was 
tried was that of the murder of a man with whom he had 
arranged to defraud an insurance company by the sub- 
stitution of a corpse pretending to be that of the insured. 
The body was found in incipient decomposition several days 
after death. There was some chloroform in the stomach 
and also some evidence of an attempt to set fire to the 



CHLOROFORM ANALYTIC METHODS. 565 

building. It is believed that the chloroform was introduced 
into the stomach by Holmes, and that the death was really 
produced by forced inhalation while the victim was drunk. 

Post-mortem Appearances. — In death from liquid chloro- 
form, the characteristic odor may usually be recognized, 
together with slow putrefaction of the body and persistent 
rigor mortis. There is also much irritation of the stomach 
sometimes accompanied with softening, and in one case with 
ulceration. 

In death from inhalation there is very often no lesion 
discoverable. At times there will be found considerable 
congestion of the lungs and bronchial tubes, and likewise 
of the vessels of the brain, together with a dark and fluid 
condition of the blood. 

Treatment. — In poisoning by liquid chloroform, the 
stomach should be immediately evacuated by the stomach- 
pump, or by a prompt emetic, and stimulants afterward 
administered. If inhalation has caused the danger, the 
chloroform should be immediately withdrawn and fresh 
air freely admitted ; cold affusion should be applied to the 
face and chest ; the inversion of the body (holding it sus- 
pended by the feet) is often successful. The tongue should 
at once be drawn out of the mouth, to facilitate respiration ; 
artificial respiration and the direct galvanic current should 
also be practiced. 

Analytic Methods. — The odor will usually be present in 
organic mixtures, such as the contents of the stomach. 
These should be distilled on a water-bath, and the distillate 
re-distilled along with calcium chlorid, and the product 
subjected to the proper tests, as odor, taste, solubility, etc. 

Toxicologic Examination. — The contents of the stomach, 
or tlie organs properly divided, along with distilled water, 



566 TOXICOLOGY. 

should be put into a large flask, the neck of which is fitted 
with a cork perforated to contain a hard glass tube, bent at 
right angles, and from twelve to fifteen inches long. The 
flask is gradually heated on a water-bath, and at the same 
time the middle of the horizontal tube is heated red-hot by 
a Bunsen flame. At a red heat, chloroform is decomposed 
into chlorin and hydrochloric acid. A slip of moistened 
litmus paper, placed at the mouth of the tube, is first red- 
dened and then bleached ; starch paper, wetted with potas- 
sium iodid, "is rendered blue; and if the end of the tube be 
made to dip into a solution of silver nitrate, white silver 
chlorid will be precipitated. The absence of any free hydro- 
chloric acid in the original material should be first insured 
by the addition of sodium carbonate. 

It is important to remember that if chloral hydrate had 
been taken by the patient just previous to death, and the 
alkali be added to the mixture for examination, the chloral 
will be decomposed into chloroform and produce all the 
above reactions. 

There are certain important questions connected with the 
administration of chloroform as an anesthetic, with which 
the physician should be familiar, such as whether persons 
asleep may be chloroformed without their being awakened 
and thus robbed or otherwise maltreated. It has been ascer- 
tained by direct experiment that this effect can be produced 
if the sleep is profound. 

Chloral Hydrate. — A solid, crystalline body, having a 
peculiar, disagreeable, pungent taste and smell ; tolerably 
soluble in water ; not inflammable. Sodium hydroxid added 
to its boiling aqueous solution instantly converts it into 
chloroform and potassium formate. It reduces copper hy- 
droxid in a manner similar to glucose. 



CHLORAL HYDRATE — ANALYTIC METHODS. 567 

Sy}}ipto}}is. — Chloral hydrate has been much used as a 
hypnotic. It is not infrequently employed in " drugging " 
liquor to assist in robbery or rape. Its indiscriminate use 
has led to many fatal results. There appears to be a ten- 
dency to accumulation, and a sudden and dangerous action 
of the drug. In moderate doses it acts as a hypnotic ; in 
large doses it produces a powerful depressant action on 
the ganglia at the base of the brain and on the spinal cord, 
causing feeble action of the heart and lungs. 

A full dose generally occasions deep sleep, followed, if 
the quantity be very large, by fatal coma. The pulse is 
usually very slow and feeble ; the face pale ; respiration 
slow, the heart being ultimately arrested in diastole. 

Much discrepancy of opinion exists as regards the fatal 
dose of chloral hydrate. Numerous instances are reported 
where ordinary doses of thirty grains have occasioned 
alarming and even fatal effects ; while, on the other hand, 
enormous quantities — over an ounce — have been swallowed 
with comparative impunity. As a rule, thirty grains may 
be considered as a maximum dose, and not to be repeated 
oftener than every six or eight hours. 

Picrotoxin has been used successfully as an antidote to 
chloral. 

Analytic Methods. — The principle involved is the con- 
version of the chloral into chloroform, through the agency 
of an alkali, as explained above. The solid matters, properly 
divided, should be diluted with distilled water, and rendered 
alkaline by sodium hydroxid, and heated in a flask, and the 
experiment conducted after the manner described under the 
head of Chloroform. 

Methyl Bromid. — Three cases of probable poisoning by 
methyl bromid have been reported by Schuler. The chief 



568 TOXICOLOGY. 

symptoms were unconsciousness and epileptiform convul- 
sions. Jaquet has reported cases undoubted as to cause, 
having arisen during a brief inhalation of the material. The 
symptoms were giddiness, disturbance of vision and un- 
steadiness of gait similar to that due to alcohol. In one of 
the cases the condition continued with some variation for 
eight days ; in the other cases it slowly disappeared during 
five weeks and left a listlessness and tendency to dizziness. 
Experiments on rabbits showed loss of muscular power, 
diminished frequency of respiration, lowered blood pressure, 
and death in convulsions. Jaquet calls attention to the 
similarity of the cases to one of poisoning by methyl iodid. 
On the other hand, they are distinguished from poisoning 
by bromoform and ethyl bromid by the duration of the 
symptoms. Ethyl bromid acts only during the inhalation, 
bromoform shortly after the ingestion and the effects soon 
disappear, while as noted above the action of methyl bro- 
mid continues for a long time after the ingestion of the drug. 
The above cases are interesting in connection with the 
recently recognized toxic effect of methyl alcohol. It is 
still a matter of uncertainty whether these effects are wholly 
due to the methyl compound or to impurities. The source 
of the methyl bromid is not given, but it was probably 
derived from the commercial alcohol, and may, therefore, 
have contained empyreumatic products. 

Nux Vomica is one of the most important poisons included 
under the class Neurotics. It is the seed of the Strych- 
nos nux vomica, a tree growing in India. Several seeds are 
enclosed in a yellow fruit. The seed is a circular disk, an 
inch or less in diameter, concavo-convex, of a light-brown 
color, covered over with short, whitish, silky hairs, ex- 



STRYCHNIN — SYMPTOMS. 569 

tremely tough and difficult to pulverize ; excessively bitter 
to the taste. Several seeds are enclosed in a single fruit. 
They contain two powerfully poisonous alkaloids — strychnin 
and hriicin, and several other alkaloids of less activity. The 
amount of contained strychnin is estimated at one half to 
one per cent, of the seed. 

The smallest fatal dose of mix vomica is thirty grains 
(about the weight of one seed), and three grains of the alco- 
hoHc extract. The symptoms, treatment, etc., are precisely 
similar to those described under the head of Strychnin. 

Strychnin. — Exists in several species of Strychnos be- 
sides the 5'. mix vomica; it is the poisonous principle of the 
5. Ignatia, or St. Ignatius^ Bean; it is also found in False 
August lira Bark. 

Strychnin is a very frequent cause of poisoning, whether 
accidental, homicidal, or suicidal. The celebrated Palmer 
case, which occurred in England in 1856, brought it promi- 
nently before toxicologists. 

Symptoms. — These vary somewhat in the time of their 
appearances, according to the form of the administration. 
The first effect is a feehng of restlessness and general un- 
easiness, with a sense of impending suffocation and want of 
air. Very soon twitching of the muscles and jerking of the 
limbs and head comes on ; these are followed suddenly by 
a violent tetanic convulsion, which pervades the whole 
body ; the legs are stretched out stiffly and widely sepa- 
rated ; the feet arched and usually turned in ; the arms are 
flexed and tightly drawn across the chest; the head is bent 
back rigidly, and the whole body flexed backward so as to 
rest upon the head and heels (opisthotonos). As the mus- 

49 



5 70 TOXICOLOGY. 

cles of the chest and abdomen are spasmodically contracted, 
livid and congested, especially around the lips ; the eyes 
prominent and staring; pupils widely dilated; the muscles 
about the mouth contracted so as to produce the expression 
denominated risus sardonicus; the pulse is very rapid and 
feeble. Sometimes there is foaming at the mouth, and the 
froth may even be tinged with blood. The intellect remains 
perfectly clear, while the patient is experiencing the most 
intense suffering, gasping for breath, and seeking in vain for 
relief in asking to be turned over, or moved, or held. The 
jaws are not always fixed during a paroxysm ; the patient 
may hence be able to speak; and as there is often great 
thirst, he may ask for water, but the effort to swallow is 
apt to intensify the spasm, as in hydrophobia, and cause 
him to bite upon the vessel. 

The paroxysm may last from half a minute to several 
minutes, when a complete relaxation occurs; the patient 
now feels exhausted and is bathed in perspiration ; the 
pupils may now become contracted. In a short time, vary- 
ing from a few minutes to half an hour, the fit returns. It 
is usually preceded by an apprehension of the impending 
danger, the special senses being exceedingly acute. The 
spasm may be brought on by the slightest cause, as the 
opening of a door, a sudden noise, a current of air, or an 
attempt to move. In some instances the violence of the 
spasm is so great as to jerk the patient out of bed. Should 
the case prove fatal, the paroxysms increase in frequency 
and violence, until at last death ensues, either from asphyxia, 
the patient dying in a paroxysm, or from sheer exhaustion 
during an interval. 

Although the intelligence continues unimpaired during 
the progress of the case, it may happen that it becomes 



STRYCHNIN — SYMPTOMS. 57 I 

clouded just before the fatal termination, in consequence of 
the asphyxia causing a deficiency of aeration of the blood, 
and the consequent accumulation of carbon dioxid. As a 
rule, when the paroxysms are once established, they pro- 
gress either to fatal termination or toward a cure within 
two hours of the seizure, though there may be some excep- 
tions to this rule. 

The time of the first manifestation of the symptoms varies 
from a few minutes to some hours ; the average is fifteen 
minutes to half an hour. Dr. G. H. Barker has reported 
the case of a young, healthy woman, who took six grains 
of strychnin, in whom violent symptoms were manifested in 
three minutes, and death took place in convulsion in half 
an hour. In Dr. Warner's case, who took, it is supposed, 
less than half a grain, the symptoms appeared in five 
minutes and death occurred in about eighteen minutes. 
In another case convulsions came on in five minutes. On 
the other hand, this interval may be protracted for several 
hours. Dr. Anderson reports the case of a man who took 
by mistake three and a half grains of strychnin, and ex- 
perienced no particular symptoms for two hours and a half, 
when he suddenly fell backward ; but on being raised he 
was able to walk home and finally recovered. Undoubtedly 
the form in which the poison is administered has much to 
do with the rapid development of the symptoms. This is 
shown in a case cited by Taylor of a boy, aged twelve years, 
who swallowed a pill containing three grains of strychnin, 
in whom no symptoms were manifested for three hours ; 
they then set in with their usual violence and death took 
place in ten minutes. This pill had been prepared with 
mucilage eight months before, and was consequently hard 
and difficult to dissolve. In the Palmer case, Cook took 



572 TOXICOLOGY. 

two pills containing strychnin. No symptoms were observed 
for an hour and a quarter, after which death occurred in 
twenty minutes. 

There are cases in which the unusual delay cannot be 
thus accounted for, but in which it must be referred to 
some individual peculiarity of the patient. Wormley men- 
tions a case where the remarkable postponement of the 
symptoms for twelve hours appeared to be owing to the 
effects of a large dose of opium that had been taken simul- 
taneously. Three grains of strychnin, a drachm of opium, 
and an indefinite quantity of quinin were taken at the same 
time. Other equally remarkable instances might be ad- 
duced, showing the same apparent antagonism between 
strychnin and opium. Nevertheless, in some experiments 
with strychnin and morphin combined, made on animals by 
Dr. Reese, the latter poison, so far from antagonizing the 
former, appeared rather to intensify it. 

The subcutaneous injection of strychnin, as also its ex- 
ternal application to a healthy mucous surface, produces a 
still more speedy manifestation of its peculiar symptoms. 
Some clinical experiments of Dr. Chisholm, of Baltimore, 
made on amaurotic patients, would seem to show that the 
human system acquires a tolerance of strychnin. 

Fatal Dose. — There is great difference as to the suscep- 
tibility to the action of strychnin. The average medicinal 
dose is about the one sixteenth of a grain, though it is cus- 
tomary to commence with a smaller quantity. The above 
dose has proved fatal to a child between two and three 
years old. Dr. G. B. Wood mentions the case of a lady 
who was thrown into alarming spasms by one twelfth of a 
grain. Dr. Reese had personal knowledge of a case of a 
gentleman who had decided spasms after taking about one 



STRYCHNIN FATAL PERIOD. 573 

twentieth of a grain. In Philadelphia recently severe 
symptoms followed the taking of one quarter of a grain of 
strychnin sulphate by an adult woman, but a fatal result 
was avoided. 

The smallest fatal result for an adult recorded is half a 
grain, which proved fatal to Dr. Warner. Dr. Ogston re- 
ports a case where three quarters of a grain destroyed a man 
in three quarters of an hour. A fatal dose for an adult may 
be stated to be half a grain to one grain. 

On the other hand, numerous instances are recorded of 
recoveries after enormous doses of this poison — ten, twelve, 
and even forty grains. In all these cases early vomiting was 
produced, which, doubtless, removed the strychnin before 
it was absorbed to a fatal extent. Besides, it is quite pos- 
sible that the poison was not of full strength. 

Fatal Period. — This, like the fatal dose, is liable to con- 
siderable variation. Dr. Warner's case terminated fatally 
in eighteen minutes. Taylor mentions two cases in which 
death occurred in ten and fifteen minutes respectively; in 
another case in five minutes; in two others in thirty minutes 
each. 

On the other hand, life has been prolonged, even after 
large doses, for several hours. In Cook's case, death oc- 
curred in an hour and a quarter after swallowing the pill. 
In the case of a woman examined by Dr. Reese, death did 
not occur for six hours after swallowing about six grains of 
strychnin ; morphin, however, had previously been admin- 
istered. Sir R. Christison reports a case in which a man 
died in fifteen minutes after swallowing a dose of mix 
vomica. 

Treatment. — Prompt and free emesis is of the greatest 
importance. Copious draughts of warm mustard water, or 



5 74 TOXICOLOGY. 

a mixture of ipecac and zinc sulphate should be given. 
The stomach-pump may be used if the spasm of the jaws 
will permit. Chloroform by inhalation appears to have been 
attended with the happiest results. The patient should be 
constantly kept under its influence, carefully watching its 
effects. Potassium bromid has also been given with the 
best results — sixty to eighty grains every hour or half hour. 
Chloral hydrate has also proved an efficient remedy in sev- 
eral cases, and amyl nitrate has been recommended, from its 
known physiological effects. Atropin has also proved effi- 
cacious as an antidote in a case when chloroform failed, 
and when the paroxysms were very severe. 

Post-mortem Appearances. — These are by no means char- 
acteristic, nor are they always similar. Probably the lesions 
most commonly observed are congestion of the brain and 
membranes, and of the spinal cord, with engorgement of the 
lungs and a dark and fluid condition of the blood. The heart 
is sometimes contracted and empty, and at others full of 
blood. The rigor mortis is usually prolonged ; in one case 
we found it existing six weeks after death. There is also 
frequently noticed a livid appearance about the mouth and 
tongue, and also of the fingers and toes. It should be re- 
membered that certain disorders of the brain and spinal 
cord, attended with tetanic convulsions, will leave precisely 
similar lesions to those just referred to as following death 
by strychnin. 

Diagnosis. — The importance of a clear diagnosis in a case 
of strychnin poisoning cannot be too strongly urged, inas- 
much as there may be in such a case a complete absence of 
all chemical proof. In the celebrated Palmer case this 
question was most thoroughly sifted on both sides. In- 
deed, this very case affords an apt illustration of just the 



STRYCHNIN — DIAGNOSIS. 575 

sort of difficulties that present themselves in forming a cor- 
rect appreciation of the symptoms. In the Palmer case the 
defense brought forward an immense array of diseases, 
which, as remarked by Tardien, ** have but a faint resem- 
blance to, and often a complete diversity from, the char- 
acteristic phenomena of strychnin poisoning." The only 
disease whose symptoms can possibly be confounded with 
those occasioned by strychnin is tetanus in its varieties of 
idiopathic, traumatic, and hysterical, and possibly some 
forms of epilepsy. 

If the expert were obliged to decide solely from the con- 
vulsions — apart from its mode of invasion and seizure, its 
duration and termination, the condition of the intervals be- 
tween the paroxysms, in fine, apart from the whole history 
of the attack — he might probably be unable to discriminate 
between a case of str}xhnin poisoning and one of tetanus ; 
but where a careful examination of all these attending cir- 
cumstances has been instituted there can be no possible 
difficulty in reaching a satisfactory conclusion. The dis- 
tinctive characters are the following: (i) In traumatic 
tetanus the history of the case, as being connected with 
some injury, such as a lacerated, contused, or punctured 
wound, involving tendons, nerves, and fascia, will always 
throw sufficient light on the case to admit of an easy diag- 
nosis; although it must not be forgotten that the most 
trifling injury, such as the insertion of a splinter of wood 
beneath the fascia, and which may have entirely escaped 
recollection, may, after the lapse of several days, give rise 
to this frightful disorder ; and such a case might be mis- 
taken for idiopathic tetanus. But as regards the latter 
form of the disorder, besides its extreme rarity in temperate 
climates, its mode of invasion (as likewise that of traumatic 



57^ TOXICOLOGY. 

tetanus), the duration of the attack and the character of the 
symptoms, are entirely different from those of strychnin poi- 
soning. In the former there are a.lways manifested certain 
prodromes, such as chills, faintness, insomnia, headache, 
vertigo, and painful tension about the diaphragm, which 
may last for several days. These, of course, are entirely 
wanting in poisoning by strychnin, and they never can be 
mistaken for the general uneasiness which precedes for only 
a few minutes the sudden outburst of convulsions in the 
case of the poison. (2) The first symptoms in tetanus are 
a painful stiffness of the neck and jaws, with a difficulty of 
moving the head ; after this there is a gradual spreading of 
the rigidity over the muscles of the other parts of the body, 
usually the trunk first, then the limbs. In some instances 
the contractions reach their greatest intensity in the course 
of a few hours ; in others, several days may elapse. To 
contrast this with a case of strychnin poisoning: in the 
latter, instead of the gradual invasion of the rigid spasms, 
commencing in the neck or jaws, there is a sudden tetanic 
seizure of all the muscles of the body simultaneously, pro- 
ducing the violent jerking of the body and the arching of 
it backward. Again, while the muscles of the neck and 
jaws are never the first to be affected by strychnin, but are 
often the last, the reverse is the case in the disease — the 
trismus being the first indication of its approach. (3) A 
third distinction is founded on the progress of the two 
cases ; while the violent paroxysm produced by strychnin 
lasts only from half a minute to one or two minutes, and is 
succeeded by a complete relaxation, in tetanus, on the con- 
trary, the rigidity is generally permanent, or if there be any 
remissions these never exhibit the character of the complete 
intermissions characterizing the action of strychnin. (4) 



STRYCHNIN — DIAGNOSIS. 57/ 

The termination of the cases is widely different ; idiopathic 
tetanus never terminates fatally in two or three hours, but 
usually several days elapse ; while in the case of the poison 
death often occurs within half an hour to two hours. Some 
cases of traumatic tetanus are reported which proved fatal 
within twelve hours ; and one remarkable case, quoted by 
Watson, of a negro who lacerated his thumb by the acci- 
dental fracture of a china dish ; he was seized with convul- 
sions almost instantly and died with tetanic symptoms in 
a quarter of an hour. This can hardly be a case of true 
tetanus ; indeed, it seems unlikely that the symptoms were 
caused by the accident mentioned. 

As regards the hysterical form of tetanus, although its 
very existence has been denied by some, especially in the 
male, it is admitted by numerous competent authorities ; 
and, inasmuch as among other forms it may assume that of 
tetanic spasms, and might occasion doubt under peculiar 
circumstances, the examiner should ascertain the previous 
history of the case, which will serve to clear up the diagnosis. 

In relation to epilepsy there ought to be no difficulty in 
the diagnosis ; the mode of seizure, the unconsciousness, 
and the peculiar clonic movements are wholly different 
from the characteristic tetanic spasms of strychnin poison- 
ing. Again, the deep stupor which terminates an epileptic 
attack contrasts widely with the complete relaxation and 
perfect intelligence that follow the strychnin spasm. 

Analytic Methods. — Strychnin occurs in the form of a 
white powder, and also in crystals, usually prismatic. It is 
almost insoluble in water — one part in seven or eight thou- 
sand. Absolute alcohol dissolves one part in about two 
hundred ; amylic alcohol, one in one hundred and twenty ; 
pure ether, one in about fourteen hundred; commercial 

50 



5/8 TOXICOLOGY. 

ether, one in about one thousand ; chloroform, one part 
in eight. It is insoluble in the fixed alkalies, and very 
sparingly so in ammonium hydroxid. The salts of strych- 
nin are very soluble in water and alcohol, but very slightly 
so in ether. The taste is intensely and permanently bitter. 
This is one of its characteristic qualities. In fact, it is the 
bitterest substance known. As the result of numerous ex- 
periments. Dr. Reese found distinct bitterness yielded by a 
solution of one grain of strychnin in several gallons of water. 
This bitter taste is one of the strongest corroborative proofs 
of the presence of strychnin. Unless the ultimate extract 
obtained by the manipulation has a bitter taste, one need 
not expect to prove the presence of the poison by the usual 
chemical tests. The mere bitterness is not of itself evidence 
of strychnin, since this quality pertains to numerous other 
substances, such as morphin, quinin, aloes, colocynth, and 
picrotoxin. 

The strong mineral acids produce no coloration with 
strychnin, provided the latter is pure; if it contains brucin 
it will impart a reddish color to nitric acid. Heated on 
porcelain, it melts slowly into a brown liquid, and is de- 
composed, giving off dense white fumes and leaving car- 
bon. It may be sublimed by heat, depositing feather-like 
crystals on a cold glass surface. 

I. The Color Test. — This is so named on account of the 
beautiful succession or play of colors that is developed by 
it. It consists in the application of a drop of pure sulphuric 
acid to a small fragment of strychnin on a white porcelain 
surface or on a watch-glass over white paper. If the 
strychnin be perfectly pure it will dissolve in the acid with- 
out any coloration. If now a fragment of potassium dichro- 
mate, manganese dioxid, lead dioxid, potassium ferricyanid, 



STRYCHNIN — DIAGNOSIS. 579 

or potassium permanganate be stirred in contact with the 
solution by means of a pointed glass rod, a play of colors 
is instantly manifested. At first it is of a rich, deep blue; 
this soon passes into violet and purple, which, in its turn, 
fades into a pink, then into a red, and finally into a dirty 
green. 

The relative duration of these shades of color depends on 
the quantity of strychnin operated on, and also on the rela- 
tive amounts of acid and the other substance. Thus, if the 
amount of strychnin be extremely minute, the blue color 
may flash out but for a moment, leaving only the violet or 
purple, which quickly passes into the red. 

The principle involved in the color-test is the action of 
oxygen (developed by the sulphuric acid on the various 
oxidizing substances above named) on the strychnin. Allen 
states that manganese dioxid is the best substance to use in 
this test. 

It is very important to have clear and definite ideas about 
this color-test for strychnin. It is not the mere production 
of a blue color that is of diagnostic value, for this might 
result from the application of potassium permanganate to 
various organic bodies in the absence of strychnin; but it 
consists in the regular succession of colors — from blue to 
violet, pink, and red, the last continuing for some time and 
ultimately changing to a dirty green. So far as is known, 
strychnin is the only substance that answers to the above 
requisition. There are others that react somewhat similarly, 
which will be noticed hereafter. 

The exceeding delicacy of the color-test deserves special 
notice. If the strychnin be perfectly pure and the manipu- 
lation be properly performed, so minute a quantity as the 
one millionth of a grain can be detected. Much depends 



580 TOXICOLOGY. 

on the manner of the experiment. Minute quantities of 
strychnin are best obtained by first making a solution of the 
alkaloid in pure water, with the addition of acetic acid of 
a definite strength. This may readily be reduced by the 
addition of more water. Fractional portions of the solution 
may be obtained by using a pipette drawn out to a capillary 
point, which will deposit minute droplets on a warmed clean 
porcelain surface. The object here is to concentrate the 
quantity to be experimented upon into as small a space as 
possible. The drop should then be carefully evaporated to 
dryness. A small drop of pure concentrated sulphuric acid 
is then applied to the deposit by means of a finely-pointed 
glass rod, and then a minute amount of manganese dioxid 
(or one of the other oxidizing bodies) is placed alongside of 
the acid solution, and then, by means of the rod, it is drawn 
through the solution and gently stirred into it. 

Interferences. — As above mentioned, the color-test prop- 
erly applied will detect exceedingly minute portions of pure 
strychnin ; but there are many organic substances whose 
presence will considerably modify and even completely dis- 
guise this test. This fact has been known to chemists since 
1850, when it was first announced by Brieger. His results 
have been confirmed, and the list of interfering bodies has 
been extended by subsequent experimenters. According 
to Lyman, potassium permanganate is the only reagent that 
will develop the color-test with strychnin when the latter is 
mixed with either morphin or quinin in excess. The most 
important of these interferences, considered medico-legally, 
is probably morphin, inasmuch as this substance might be 
likely to be given to allay the severity of the strychnin 
spasms, and would consequently be associated with the 
strychnin extracted from the body after death. A large 



STRYCHNIN FALLACIES. 58 I 

number of experiments made by Dr. Reese clearly confirm 
the fact of the interference of morphin with the usual color- 
test for strychnin, both in the pure state and when mixed 
with organic matters. The important point to establish 
was that this interference was especially obvious when both 
alkaloids were present in only very minute quantities, such 
as the one hundredth of a grain or less ; in such cases the 
strychnin is not discoverable by the color-test if the mor- 
phin is in excess, and is barely manifested when in equal 
quantity. One experiment by Dr. Reese will be men- 
tioned : A cat was poisoned " with one twentieth of a grain 
of strychnin and one tenth of a grain of morphin. The 
ultimate extract obtained from the stomach by Stas' process 
entirely failed to yield the color-test, although the bitter- 
ness of the extract and the fact that its solution produced 
the characteristic tetanic convulsions in a number of frogs 
distinctly proved the existence of strychnin." 

Admitting, then, the fact of these interferences, it is well 
to remember that practically they may be avoided by the 
employment of chloroform instead of ether as the proper 
solvent to extract the strychnin from organic mixtures; 
morphin and other interfering substances being but slightly 
soluble in this menstruum. 

Fallacies. — Exception has been taken to the color-test on 
the ground that other substances besides strychnin will 
yield colors similar if not identical when similarly treated, 
but a careful attention will readily avoid all difficulty. The 
substances alluded to are curarin, veratrin, cod-liver oil, 
salicin, santonin, anilin, narcein, papaverin, and solanin ; 
but in relation to most of these a radical ground of dis- 
tinction is that they are colored by sulphuric acid alone, 
which is not the case with strychnin. A salt of anilin is 



582 TOXICOLOGY. 

not colored by the acid alone, but only in the presence of 
one of the above-mentioned oxidizing bodies ; but the 
former is first colored green, then a persistent blue, and 
finally black. 

Curarin has many points of resemblance to strychnin ; it 
is very bitter ; it yields a succession of colors with sulphuric 
acid and potassium dichromate, but it is much more soluble 
in water, forms amorphous compounds with potassium di- 
chromate, and is colored purple by strong nitric acid ; it is 
nearly insoluble in chloroform and readily soluble in alka- 
lies. Its physiological effects are the opposite of those of 
strychnin. 

Cod-liver oil, when treated with sulphuric acid alone, 
affords a play of colors somewhat like those presented by 
strychnin. 

The fact that a mixture of hydrastin and morphin will 
give a reaction with sulphuric acid and potassium dichromate 
somewhat similar to that produced by strychnin with the 
same reagents, was first stated by J. U. Lloyd, and is some- 
times called the " Lloyd reaction." The reaction has been 
studied by several investigators, notably Fullerton {Amer. 
Med., May 27, June 3 and 10, 1905). As the mixed hy- 
drastin and morphin give distinct color-play with sulphuric 
acid alone, there seems to be no practical confusion with 
strychnin, which gives no color with sulphuric acid. 

2. Galvanic Test. — This acts on the same principle of 
presenting nascent oxygen to the strychnin, but in this 
instance it is evolved by electricity. A drop of a dilute 
solution of strychnin is placed in a small depression made 
on platinum foil, or in a platinum capsule, allowed to evap- 
orate to dryness, and then moistened with a drop of sul- 
phuric acid. The foil (or capsule) is connected with the 



STRYCHNIN — PICRIC ACID. 583 

positive pole of a single cell of Grove's battery, and the acid 
is touched with a platinum terminal from the negative pole. 
Instantly the violet color will flash out on the metal, and on 
removing the pole from the acid the tint will remain. 

3. Sodium hydroxid or ammonium hydroxid precipitates 
the alkaloid from a somewhat concentrated solution in the 
crystalline form. The best method is to expose a drop of 
the solution on a glass slide to the vapors of ammonium 
hydroxid and place it under the microscope ; the beautiful 
formation of the long stellate prismatic crystals can easily 
be distinguished ; these can be identified by touching them 
with a drop of sulphuric acid and a small amount of man- 
ganese dioxid, when the play of colors will take place. 

4. Potassium Dichromate. — A solution of this salt throws 
down from a strychnin solution a bright-yellow precipitate, 
which soon becomes crystalline. Placed under the micro- 
scope these crystals appear in groups mingled with octa- 
hedral plates. When dried, these should be verified by 
touching them with a drop of sulphuric acid, which pro- 
duces the play of colors. This is a satisfactory test. 

5. Picric Acid. — A solution of this acid precipitates 
strychnin from its solution in the form of abundant yellow 
crystals. The best mode of showing it is to add a drop of 
the solution to one of strychnin on a glass slide, and view 
the reaction under the microscope. The precipitate which 
first forms soon assumes the appearance of tufts of yellow 
crystals of a peculiar claw-like form. These, as in the 
former experiment, may be subjected to the color-test by 
the same method. 

Besides the above tests there are others of inferior value, 
as platinum chlorid, potassium iodid, and potassium thio- 
cyanate. 



584 TOXICOLOGY. 

6. Physiologic Test. — The extreme susceptibility of the 
frog to the action of strychnin was first employed by Mar- 
shall Hall as a test for this poison. It may be applied 
either by immersing a small frog in the strychnin solution 
or by injecting it into the throat of the animal or, preferably, 
under the skin. Dr. Reese reports that he has had many 
satisfactory results with this test. One of these experiments 
demonstrates very clearly the extreme susceptibility of the 
frog to the influence of strychnin : " The one five-hundredth 
of a grain of strychnin was put into the throat of a middling- 
sized frog ; it was convulsed and died in about thirty 
minutes. The extract obtained from the stomach by Stas* 
process, although it afforded no perceptible color-test, had 
a bitter taste, and produced tetanic spasms in several small 
active frogs." 

Dr. Reese's experiments in this line further demonstrated 
the fact that while morphin, when present in excess with 
strychnin in small quantities, has the power to disguise the 
color-test, it affords no obstacle to the employment of the 
frog-test. Two experiments may be quoted under this 
head : " A frog weighing thirty-five grains was immersed 
in a solution of the strength of one fourth of a grain of 
strychnin and eight grains of morphin to one pint of water ; 
it was convulsed in twenty minutes. Another animal, 
rather smaller, was convulsed in five minutes." (In these 
experiments only a small portion of the solution was used, 
less than a fluid-drachm, put into a conical glass, in which 
the hind-quarters only of the animal were immersed.) " A 
cat was poisoned with one twentieth of a grain of strychnin 
and one tenth of a grain of morphin. The stomach, on ex- 
amination by Stas' process, failed to yield the color-test ; 
but the watery solution of the extract produced most de- 



STRYCHNIN TOXICOLOGIC EXAMINATION. 585 

cided tetanic convulsions in eight frogs, generally resulting 
in death." 

The physiologic test, although so important for cor- 
roboration, should not be relied on exclusively in the ab- 
sence of the chemical tests, since several other substances, 
including some of the ptomains, produce somewhat similar 
symptoms. 

Toxicologic Examination. — The stomach properly divided, 
together with its contents, and a sufficient quantity of dis- 
tilled water, should be made distinctly acid with pure acetic 
acid. If the elaborate process of Stas is to be employed, 
the strongest alcohol must be used instead of water. In 
either case the mass should be digested on a water-bath for 
several hours. A high temperature is objectionable, as it 
dissolves out the starchy matters. After cooling, it is 
strained through muslin, and the solid matters washed with 
dilute alcohol, and pressed. The liquid should next be 
concentrated by evaporation, and filtered through paper. 
It should now be evaporated to dryness. The residue will 
contain any strychnin that may be present, in the form of 
acetate, mixed with organic matter. This residue should 
now be thoroughly mixed with a small quantity of distilled 
water containing a few drops of acetic acid, then filtered 
through paper, and the filtrate shaken up successively with 
ether, benzene, chloroform, and amylic alcohol, which will 
remove many impurities, but will not dissolve the strychnin 
in the acid solution. It is then poured into a glass tube or 
flask, and an excess of sodium carbonate or ammonium 
hydroxid added, which liberates the strychnin. Pure chlo- 
roform, slightly in excess of the mixture, is now added, and 
the whole briskly shaken together for some minutes. Blyth 
recommends to add the chloroform before the alkali ; the 



586 TOXICOLOGY. 

strychnin is more soluble before it assumes the crystalline 
condition. The chloroform dissolves out the alkaloid, and 
collects at the bottom of the mixture after the lapse of 
some time. 

To separate the chloroform from the supernatant liquid 
the easiest practical method is to transfer the whole mix- 
ture to a stoppered glass funnel, or, what answers equally 
well, a glass syringe of proper size after removing the 
piston, and having previously contracted the nozzle to a 
fine point by means of the flame. Before introducing the 
liquid, this small aperture should be plugged with a splinter 
of wood, and about half a drachm of pure chloroform first 
poured into the syringe, sO' as to about fill the narrow por- 
tion. The mixture is now to be carefully poured in and a 
sufficient time allowed to elapse for the chloroform to sepa- 
rate and settle to the bottom. By placing the thumb over 
the larger aperture of the syringe, and withdrawing the 
wooden plug, it will be very easy to control the flow of the 
contents. A few drops may be allowed to fall successively, 
as each one dries, into a warmed watch-glass or porcelain 
capsule^ for a trial by the color-test. The whole of the 
chloroform is then permitted to flow out into one or more 
capsules or watch-glasses, great care being taken not to 
allow any of the other mixture to escape along with it. The 
remaining alkaline liquid may be shaken up with an addi- 
tional portion of chloroform, and the separation again made 
as before. All the chloroform is now permitted to evapo- 
rate spontaneously to dryness. The contained strychnin, if 
of notable quality, will usually be found in the deposit in an 
amorphous form. 

As a trial-test, a portion of this extract should now be 
examined by the taste for bitterness ; by the color-test 



STRYCHNIN TOXICOLOGIC EXAMINATION. 587 

(although this may not be very satisfactory, on account of 
the mixture with organic matter), and by the frog-test. 
The remaining portion of the extract is to be dissolved in a 
minute quantity of water, acidulated with acetic acid, filtered 
and subjected to the usual tests. 

The main difficulty in considering this experiment arises 
from the presence of organic matters in connection with the 
strychnin. If the chloroform extract has a yellow color 
(denoting its impurity), a few drops of strong sulphuric acid 
should be added to it and thoroughly stirred with a glass 
rod and gently heated. This blackens, destroys, and car- 
bonizes the organic matter and converts the strychnin into 
a sulphate ; add a few drops of water. After standing a 
short time the dark liquid is filtered, sodium carbonate or 
ammonium hydroxid added in excess, then pure chloro- 
form, as explained above. The second extract thus pro- 
cured is generally sufficiently pure for all practical pur- 
poses. 

It not infrequently happens, when operating on complex 
organic mixtures by the chloroform process, that difficulty 
is experienced in getting the chloroform to separate from 
the alkaline solution, the whole mass forming a sort of 
emulsion. In such a case the tube may be immersed in 
hot water for some time, and if this does not answer, nothing 
remains but to agitate the mixture several times successively 
with about half its volume of pure water, allowing it to rest 
each time, and separating the chloroform as before directed. 
The separation can often be promoted by the use of a cen- 
trifugal machine. The mixture is slightly acidulated by 
acetic acid, then transferred to a small dish, and evaporated 
to dryness on a water-bath ; the residue is stirred with a 
very small quantity of pure water ; the solution is filtered, 



588 TOXICOLOGY. 

rendered slightly alkaline, and again agitated with fresh 
chloroform, which usually will readily separate. 

The method of dialysis has been recommended by some 
authorities, but does not seem to be as satisfactory as the 
one just described. 

Detection in the Tissues and Blood. — Strychnin is ab- 
sorbed into the circulation and deposited in the various 
organs, just like the mineral poisons. The rapidity with 
which the absorption takes place is shown in a case men- 
tioned by Taylor, where a man took five grains of the poison 
by mistake, and died in half an hour. Strychnin was dis- 
covered in the stomach in the quantity of one grain ; it was 
also detected in the liver and tongue. This case shows that 
within half an hour four fifths of the poison had been re- 
moved from the stomach (or could not be detected there 
by chemical research), and had been diffused throughout 
the body. There are, however, other cases where the cir- 
cumstances were apparently just as favorable for the absorp- 
tion and diffusion of the poison, but where there was a total 
failure to detect it in the organs after death. 

The process is the following : The organs are to be finely 
crushed and digested in strong alcohol, acidulated with 
sulphuric acid in the proportion of eight drops to the fluid- 
ounce of the mixture; this should be heated below 212° F. 
for about an hour ; when cool, it is to be filtered and con- 
centrated, as before directed. The residue is then nearly 
neutralized by sodium hydroxid, care being taken to main- 
tain an acid reaction, then filtered and evaporated nearly to 
dryness. To the cool residue a drachm or two of strong 
alcohol is added and thoroughly stirred with it ; this dis- 
solves out the strychnin sulphate, and leaves the potassium 
sulphate and the organic matters. The alcoholic solution 



STRYCHNIN — FAILURE TO DETECT. 589 

is now filtered, evaporated almost to dryness, the residue 
stirred with pure water, rendered alkaline by sodium hy- 
droxid, and finally agitated with chloroform, which deposits 
the alkaloid, if present, on evaporation. 

Dr. Taylor recommends acetic acid and ammonium 
hydroxid in these cases. 

The method of Rodgers and Girdwood is somewhat 
similar ; they employ hydrochloric acid and ammonium 
hydroxid as the reagents along with chloroform. 

Strychnin may be recovered from ^he blood by a similar 
process. In some experiments of Wormley the poison was 
detected in the blood of dogs and cats, where death took 
place in three and six minutes respectively after its admin- 
istration. This shows the extreme rapidity with which it is 
absorbed. 

Detection in the Urine. — The urine should be evaporated 
to a syrupy consistence, acidulated with acetic acid mixed 
with an ounce of strong alcohol, filtered and evaporated to 
near dryness. The residue is to be stirred with pure water, 
filtered if necessary, sodium hydroxid added in excess and 
agitated with chloroform. 

Failure to Detect. — It must be admitted that the most 
careful analysis sometimes fails to discover this poison in 
the body after death, and that, too, where the circumstances 
were apparently favorable to it. This failure may some- 
times be ascribed to the smallness of the dose, and again 
possibly to some interference — probably some ptomain, 
especially when there is putrefaction ; though mere putres- 
cence of the body is of itself no obstacle to its detection, 
since it has been recovered months after death, and where 
the body was in an advanced state of decomposition. Allen 
has reported a case in which strychnin was found in organic 



590 * TOXICOLOGY. 

matter after seven years. Dr. Leffmann found it in vomited 
matter which had been kept for nine years. Christison, 
Taylor, and other well-known authorities, have at times 
been foiled in their efforts to detect the poison. In a case 
that Dr. Reese examined some years ago, in which a woman 
was poisoned it was alleged with six grains of strychnin, 
and in which death was postponed for the unusually long 
period of six hours, there was a similar failure to detect the 
poison eight weeks after death, although the body was well 
preserved. In this c^se (as already mentioned) morphin 
had also been administered, which may have interfered with 
the usual color-test. 

Brucin. — This alkaloid is generally found associated with 
strychnin. It occurs either in the form of a white powder 
or in colorless prismatic crystals. It is more soluble in 
water and alcohol than strychnin. It is freely soluble in 
chloroform and alcohol. It has an intensely bitter taste. 
Concentrated sulphuric acid dissolves it, giving a faint rose 
coloration. It does not respond to the color-test of strych- 
nin. Nitric acid gives a characteristic blood-red color. 

Its poisonous properties are similar to those of strychnin, 
though much less intense. As the symptoms of poisoning 
by it are similar to those caused by strychnin, the toxicolo- 
gist should guard against being deceived in a medico-legal 
investigation, in the event of not discovering strychnin by 
the usual color-test. In such a case it would always be 
proper to search for brucin. 

Tests. — (i) The characteristic reagent is nitric acid, 
which instantly produces a blood-red color with a speedy 
solution of the alkaloid. If heated the color changes to 
yellow. If after cooling a drop of the solution of stannous 



CEREBRO-SPINAL NEUROTICS. 59 I 

chlorid be added, the color changes to a beautiful purple. 
The somewhat similar red color produced on morphin by 
nitric acid is not changed by protochlorid of tin. 

(2) Sulphuric Acid and Potassium Nitrate. — Touch the 
fragment of brucin with a drop of strong sulphuric acid, and 
a faint rose color is produced; then add a small crystal of 
potassium nitrate, when the color changes to a deep orange- 
red. 

(3) Ammonium hydroxid produces with a drop of brucin 
solution a beautiful crystallization, viewed by the micro- 
scope. 

Blyth regards methyl iodid as the best test for brucin. 
If it is added to a strong alcoholic solution of brucin, circu- 
lar rosettes of crystals appear. This test does not act with 
strychnin. 

The frog-test is equally applicable to brucin, allowing for 
its comparative inferiority in strength to strychnin. 

The toxicologic examination for brucin is conducted in 
the same manner as described for strychnin. The ultimate 
extract is to be tested by nitric acid and stannous chlorid. 
Brucin has been detected in the blood of animals poisoned 
by it. 

BELLADONNA. 

Belladonna {Deadly Nightshade). — The leaves, berries, 
and root of Atropa belladonna are violently poisonous. The 
leaves and root are used in medicine. Children are fre- 
quently poisoned by eating the berries. Belladonna is the 
most important member of a group of plants that contain 
alkaloids that dilate the pupil from which they are col- 
lectively called Mydriatics. They comprise Belladonna, 
Stramonium, Hyoscyamus, and several species of Solanum. 

Symptoms. — A sense of heat and dryness in the mouth 



592 TOXICOLOGY. 

and throat, difficulty of swallowing, nausea, vomiting, 
giddiness, extreme dilatation of the pupil, loss of vision, 
flushed face, sparkling eyes, delirium of an excited, mani- 
acal character, spectral illusions, convulsions, followed by 
stupor and coma. Irritation of the urinary organs fre- 
quently occurs, such as strangury, suppression of urine, 
and hematuria. A scarlet eruption is often observed over 
the skin. Some of these effects have been produced by the 
external application of belladonna in the form of a plaster or 
liniment. The symptoms of belladonna poisoning usually 
show themselves in from half an hour to two hours, occa- 
sionally sooner ; they do not generally terminate fatally. 
Death, when it occurs, usually takes place within twenty- 
four hours. 

In case of death from the leaves or seeds of belladonna, 
these can usually be distinguished in the alimentary canal 
by their botanical characters, as shown by the microscope. 

Atropin. — This alkaloid is the active principle of bella- 
donna and is a very powerful poison, producing symptoms 
similar to those above described, only more speedily. The 
application of a weak solution to the eyes has occasioned 
symptoms of belladonna poisoning. Used hypodermically, 
even in doses of one fiftieth to one tenth of a grain, it occa- 
sions at times violent symptoms. Employed in this manner 
in combination with rnorphin in excess its activity appears 
to be modified. Death has resulted from the external use 
of a strong ointment of atropin. 

The following are some recently reported cases. Atropin 
poisoning now often occurs by mistaking the solution for 
rnorphin. 

I. A weak, ii -year-old, boy drank a watery solution of 50 



ATROPIN. 593 

milligrams (five sixths of a grain) of atropin sulphate. Dur- 
ing the first three hours the mother noticed that the boy 
made frequent visits to the water-closet, and was very rest- 
less. He finally developed delirium of such intensity that 
two persons could scarcely hold him. The skin was pale, 
the pulse small and very rapid, the pupils widely dilated 
and insensitive. When seen by the physician, after the ex- 
piration of three hours, it was considered useless to employ 
lavage. \'inegar was administered and an enema of half a 
gram (7.5 grains) of chloral hydrate. The delirium abated 
very much and the patient slept for two hours, but, when he 
awoke, excitement again appeared, and continued during the 
night. By morning the condition had improved, but oc- 
casional delirium still appeared. The boy saw white mice, 
looked for money in the bed and had other delusions. He 
recovered, but complained, for ten days after the taking of 
the poison, of headache, dryness of throat and disturbed 
vision. 

2. A woman, 57 years old, affected with rectal cancer, had 
been treated during a long period with morphin to relieve 
the suffering. By mistake she received at 2.30 P. j\I. 5 
milligrams (one thirteenth of a grain) of atropin. At 4 
o'clock she had a bloated and ruddy face, complained of 
much discomfort and of a marked bitter taste. At 6 o'clock 
she had developed a very strong erythema of the face, which 
was much swollen, the pupils were dilated to the maximum 
and there was dryness of the throat and thirst. At 6.30 
(the mistake not having been as yet recognized) another 
dose of the atropin was given, whereupon she became delir- 
ious and had to be held down to the bed. She became calm 
and went to sleep, about 9 o'clock, at which time the error 
was discovered, and 40 milligrams (two thirds of a grain) of 
51 



594 TOXICOLOGY. 

morphin were injected subcutaneously. Strong coffee was 
also given. The pupils were dilated, insensitive and the face 
pale. By the next morning the condition was so far im- 
proved that she could answer questions in a weak voice, but 
apparently did not recognize persons. She complained still 
of thirst and dryness of the throat. 

3. A woman, aged 28, was given, by mistake, a subcu- 
taneous injection of atropin (3 milligrams, equivalent to one 
twentieth of a grain). In an hour her face became erythem- 
atous, with twitching in the left arm and dryness of throat. 
She expressed much alarm, but lay quiet with dilated im- 
movable pupils. An injection of a quantity of morphin equal 
to that of the atropin soon produced sleep and the next 
morning she exhibited no unfavorable symptoms. 

Fatal Dose. — One half to three quarters of a grain may 
be regarded as a minimum fatal dose for an adult. The 
criminal administration of this poison is very rare. Taylor 
records a case where a surgeon of a workhouse was fatally 
poisoned by a nurse by administering it in milk. The diag- 
nosis is not always easy, since the same symptoms are pro- 
duced by hyoscyamus and stramonium. There appears to 
be a special tendency to its elimination from the system by 
the kidneys. Guy states, on the authority of Harley, that 
the presence of atropin in the urine can be readily proved 
within twenty minutes after the injection under the skin of 
one forty-eighth to one ninety-sixth of a grain by the action 
of the urine on the eye. Twelve drops will largely dilate 
the pupil and maintain it in that state for several hours. 

Treatment. — The immediate evacuation of the stomach 
by an active emetic or by the stomach-pump. There is no 
chemical antidote. Morphin, which should be carefully and 
repeatedly administered, seems to be useful. See also the 



ATROPIN ANALYTIC METHODS. 595 

treatments followed in the recent cases cited on the preced- 
ing page. The subcutaneous injection of pilocarpin has 
been found very effectual by Ringer and others. 

Post-mortem Appearances. — These are not characteristic. 
There may be congestion of the vessels of the brain, with 
some red patches of the stomach and esophagus. When 
the poisoning has resulted from eating the ripe berries, the 
whole lining membrane of the alimentary canal may be dyed 
of a purple color, and portions of the berries and seeds 
may be discovered in the intestines or in the stools. The 
blood is usually fluid and dark-colored. 

Analytic Methods. — Atropin, when pure, occurs in white 
crystalline tufts. Its taste is acrid and bitter ; slightly solu- 
ble in cold water, very soluble in alcohol, ether and chloro- 
form. It sublimes at 200° F. Its color is not changed by 
either of the mineral acids. It has alkaline properties, neu- 
tralizing acids and forming salts. If a minute quantity be 
evaporated to dryness with a few drops of a solution of 
barium hydroxid, and heated strongly, an odor is evolved 
resembling that of hawthorn (Blyth). 

Sodium hydroxid throws down from solutions of atropin 
salts a precipitate which ultimately becomes crystalline. 
That produced by ammonium hydroxid remains amor- 
phous. It is also precipitated by gold chlorid and by picric 
acid. lodin in potassium iodid gives a reddish-brown pre- 
cipitate with a very minute portion, but this is not charac- 
teristic. Wormley considers bromin in hydrobromic acid 
to be the characteristic test for atropin. The precipitate is 
at first amorphous, of a yellow color ; but it soon becomes 
crystalline. It is insoluble in acetic acid, and but slightly 
so in either of the mineral acids. The one ten-thousandth 
to one twenty-five-thousandth of a grain will give satisfac- 
tory results with this reagent. 



Sg6 TOXICOLOGY. 

Another delicate test is that of Vitali. A small portion 
is covered with a little fuming nitric acid, and dried on a 
water-bath, and when cold is moistened with a drop of 
a solution of potassium hydroxid in absolute alcohol; a 
violet color is instantly produced, which soon passes into a 
fine red. 

Free atropin, as obtained by evaporating its chloroform 
or ether solution (after liberation of the alkaloid from one of 
its salts by ammonium hydroxid), gives a red color with 
phenolphthalein. This reaction is common to hyoscyamin 
and hyoscin, and is also produced by the artificial base 
homatropin, but is not given by any other alkaloid in com- 
mon use (except, according to Pliigge, the volatile bases 
conin and nicotin). Fliickiger, who first observed the 
peculiar behavior of the tropeines with phenolphthalein, 
recommends that a minute quantity of the alkaloid to be 
tested should be placed on phenolphthalein paper (this 
should be freshly prepared), which is then wetted with 
strong alcohol. No coloration will be produced at first, 
but on allowing the alcohol to evaporate^, and touching the 
alkaloid with a drop of water, a brilliant red coloration will 
appear. On adding alcohol the color is destroyed, but 
appears again as the spirit evaporates. 

Toxicologic Examination. — We should first of all en- 
deavor to discover any seeds or remains of the leaves or 
berries of the plant. The vomit and stools should, if possi- 
ble, be also examined for these. The stomach with its con- 
tents, and other organs properly comminuted, should be 
treated after a modification of Stas' process, alcohol being 
used as the solvent, along with sulphuric acid. After heat- 
ing, straining, evaporating, purifying by pure ether or amyl 
alcohol, removing the ether, and adding solution of potas- 



STRAMONIUM. 597 

sium hydroxid in excess, the ultimate extract is obtained 
by chloroform, and tested first with the bromin test, which, 
if successful, may be followed by the other tests. 

The physiological test consists in applying a portion of 
the ultimate extract to the eyes either of a man or one of 
the lower animals, as the rabbit. The minutest quantity 
wall produce the characteristic dilatation of the pupil. It 
must, however, be remembered that other members of this 
class of alkaloids will produce a similar result, and that 
mydriatic ptomains may be extracted from decomposed 
tissues. 

The rabbit evinces a remarkable tolerance for belladonna 
and its alkaloid. It will live exclusively on the former for 
many days, and tolerate enormous doses of the latter, 
either by the stomach or subcutaneously, without percep- 
tible efifects. 

STRAMONIUM, HYOSCYAMUS, AND SOLANUM. 

Stramonium (Thorn Apple, Jamestown Weed). — The 
Datura stramonium is a common plant, abounding in this 
country and also in Europe. It grows freely on waste 
grounds ; other varieties occur in India. All parts of the 
plant are poisonous, especially the seeds and fruit. Its active 
alkaloid principle has been called daturin, but is now re- 
garded as identical with atropin. 

Cases of poisoning by stramonium are usually accidental, 
and chiefly occur in children from eating the seeds. 

Symptoms. — Very similar to those produced by bella- 
donna, such as dryness of throat, with difficulty of swallow- 
ing, dilated, insensible pupil, violent and incoherent dilirium, 
nausea, vomiting, headache, vertigo, ringing in the ears, 



598 TOXICOLOGY. 

Spectral illusions, followed by stupor and coma. Some- 
times there are convulsions and paralysis, together with a 
scarlet efflorescence on the skin. The external application 
of the bruised leaves has occasioned symptoms of poisoning. 

The following case was reported in a Spanish journal : 
A man, forty-four years old, who had been directed to use 
the dried leaves of Dahtra stramonium for attacks of asthma, 
misunderstood the advice and drank an infusion of about 
six grams (ninety grains) in water. He was affected with 
a tickling sensation in the throat, soon became unconscious 
and remained so for an hour. On returning to conscious- 
ness, the breathing was shallow, sibilant and rapid (50 per 
minute), the pulse 96, full and tense, the face slightly cya- 
nosed, the pupils dilated and insensitive to light. There 
was free flow of saliva. The treatment was washing out 
the stomach with water and the administration of mild 
stimulants. He improved promptly and was well the next 
day. 

In India, a species of Datura is employed by the thugs 
for the purpose of drugging their victims. 

Post-mortem Appearances. — Very similar to those result- 
ing from belladonna. There is nothing characteristic. The 
seeds and remains of the leaves may be discovered in the 
alimentary canal, if these have been the cause of death. 

Treatment. — The same as that recommended for bella- 
donna poisoning. 

Analysis. — The seeds are of a black or brown color, kid- 
ney-shaped, with a wrinkled surface. They are much larger 
than those of belladonna or hyoscyamus. According to 
Guy, it requires one hundred and twenty henbane seeds 
and ninety of belladonna to weigh one grain, but only eight 
of stramonium. 



SOLANUM. 599 

The method of procuring the alkaloid from the stomach 
and organs is the same as that above described for atropin. 

Hyoscyamus (Henbane). — The Hyoscyamus niger grows 
both in America and Europe. All parts are poisonous. 
The root is tapering, resembling that of the parsnip, for 
which it has often been mistaken. The medicinal prepara- 
tions from the plant are extremely variable and uncertain, 
depending very much on the mode of growth, collection, 
and preparation. 

The sy)npto}}is, in general, resemble those of belladonna 
and stramonium. 

Analysis. — It can only be identified in the matters vom- 
ited, or in the stomach and intestines after death, by the 
botanical character of the seeds, or fragments of the leaves 
discovered. 

Hyoscyamin, the alkaloidal principle, forms in white, 
silky crystals, inodorous when pure, but is usually found 
possessing a disagreeable smell ; taste acrid. It is difficult 
to isolate. There is no special chemical test for it. It dilates 
the pupil, like atropin. It speedily passes into the urine 
when swallowed. 

Solanum. — Three species of the genus Solanum are usu- 
ally referred to in the books as possessing poisonous proper- 
ties ; these are S. dulcamara, Bittersweet or Woody Night- 
shade ; 6^. nigrum, Garden Nightshade ; and 5'. tuberosum, 
Common Potato. They all contain a substance called solanin. 

The S. dulcamara is cultivated in gardens as an orna- 
ment. Its berries are sometimes eaten by children, occa- 
sioning poisonous results. The dried stems are used me- 
dicinally. 



600 TOXICOLOGY. 

The vS". nigrum produces white flowers and black berries. 
The latter, like the fruit of the 6^. dulcamara, have fre- 
quently proved poisonous to children who have swallowed 
them. They are more powerful in their effects than the 
others. 

The following case shows the effects of a poisonous dose 
of this drug. A boy nearly four years old, ate some ber- 
ries of the plant growing near his home, as was learned 
subsequent to the full development of the symptoms. There 
was at first active movement of the bowels, which finally 
became involuntary. The next morning he had fever and 
cramps. When seen by the physician at ii A. M., he was 
lying in a stupefied condition, but answered questions. The 
skin was reddened and covered with sweaty the pulse strong 
and quick, the temperature 102.9° F. The pupils were 
symmetrically dilated but not to the maximum, the reflexes 
were increased. Occasional cramp-like shivers occurred. 
The involuntary discharges from the bowels contained 
numerous fragments of the berries. As eighteen hours had 
passed since the poisonous material had been taken, no at- 
tempt was made to wash out the stomach or to use emetics. 
Enemata were employed to subdue the enteritis, and Dover's 
powder was given. This caused vomiting. The boy was 
seen again at 4 P. M., but had become much worse and at 
8 P. M. died. 

vS. tuberosum is the common potato. The berries and 
young shoots have proved poisonous, the former fatally in 
the case of a young girl. Christison quotes an instance in 
which four persons of a family were seized with alarming 
symptoms, such as vomiting, coma, and convulsions, after 
eating potatoes that had commenced to sprout and shrivel. 

The general symptoms produced by solanin are very 



SOLAN UM. 60 1 

similar to those resulting from the mydriatics. It is much 
less powerful than the other bodies of this class. 

When pure, solanin is in the form of delicate acicular 
crystals, nearly insoluble in water, soluble in alcohol, less 
so in ether, insoluble in chloroform. It is also soluble in 
amy lie alcohol. The hot solution in the latter has the prop- 
erty of gelatinizing- on cooling, even in so small a quantity 
as one part in a thousand. Cold sulphuric acid first changes 
it into an orange-yellow, and then dissolves it, the solution 
becoming brown. Nitric acid dissolves it, the solution 
being at first colorless, and subsequently changing to a rose- 
red tint. The former acid is the best test for it. Other 
reagents do not give characteristic results. 

Solanin is separated from organic mixtures by a modifi- 
cation of Stas' process ; alcohol and sulphuric acid being 
employed as the solvent, and warm alcohol to separate the 
final extract. 

Cocain. — This is a crystalline alkaloid, found in the 
leaves of the Erythroxylon coca. It is colorless ; has a bit- 
ter taste ; is nearly insoluble in water and alcohol ; soluble 
in ether. In small doses it is cerebral, cardiac, respiratory, 
and nervous stimulant. Overdoses produce great embar- 
rassment of the heart and lungs, the pulse becoming small, 
rapid, and intermittent ; respiration slow and feeble. Death 
occurs from spasm of the heart and muscles of respiration. 
It also occasions delirium and hallucinations, and likewise 
dilates the pupils, whether taken internally or externally. 
It is sometimes taken to correct the morphin habit, but is 
very apt to substitute its own habit upon the unfortunate 
patient. 

Cocain is valuable as a local anesthetic in from 4 to 10 
per cent, solutions, as an application to painful affections 
52 



602 TOXICOLOGY. 

of the nose, ear, and throat; also in minor surgical opera- 
tions. This local application sometimes produces danger- 
ous symptoms ; in one case so small an amount as two 
thirds of a grain produced death. Caffein, nitroglycerin, 
amyl nitrite, and strychnin have been used as antidotes with 
advantage. 

The cocain habit is marked by insomnia^ loss of digestive 
power, enfeeblement of mind, emaciation, hallucinations, 
delirium, and general loss of health — a condition much re- 
sembling the worst effects of opium. 

Cocain is usually employed in the form of hydrochlorid. 
Alkaloids of this type are contained in many of the prep- 
arations now used for producing local anesthesia in the ex- 
traction of teeth. A small amount of phenol is also often 
present in these liquids. 

The most striking tests for cocain or its salts in aqueous 
solution are the crystalline precipitates produced by gold 
chlorid, platinum chlorid and picric acid. lodin in potas- 
sium iodid produces a rose-colored precipitate in very dilute 
solution, and a brown one in stronger solutions, which is 
not crystalline. When cocain is subjected to Vitali's test 
(see under atropin), a distinct odor of peppermint or citron- 
ella is noticed. 

Recently several artificial substances, analogous to cocain 
in composition and properties, have been introduced into 
medical practice, especially as local anesthetics. Among 
these is eucain. It is sold principally in the form of hydro- 
chlorid. Little is known as yet as to its toxicology. 

Several of the cerebro-spinal neurotics are conveniently 
classified as depressants, because they produce great depres- 
sion of the muscular system, though they differ materially 
in other respects. 



TOBACCO SYMPTOMS. 603 

The anesthetics of this type have been much used lately 
for the so-called '* lumbar puncture," that is, the introduc- 
tion of a solution into the spinal canal for the purpose of 
producing" general anesthesia of the lower part of the body 
without unconsciousness. Fatal results have occasionally 
happened from this. 

TOBACCO AND LOBELIA. 

Tobacco is the dried leaves of Nicotiana tabacum, a plant 
belonging to the natural order of Solanacece. It owes its 
activity and poisonous properties to a volatile oily alkaloid 
(nicotin), which somewhat resembles conin, and which 
exists in different proportions in different specimens of the 
leaves, varying from two to eight per cent. 

Symptoms. — A large dose of tobacco (or even a small one 
to those unaccustomed to its use) produces very decided 
symptoms. Very soon after taking it, either by swallowing 
or enema, it occasions nausea, giddiness, a sense of confu- 
sion of the head, vomiting, severe retching, great prostra- 
tion, heat in the stomach, frequent and very feeble pulse, 
cold, clammy skin, trembling of the limbs, and sometimes 
severe purging. Respiration is difficult, and urination in- 
voluntary. In some cases there is violent pain in the abdo- 
men; in others there is a great sense of depression and of 
impending death. Convulsions of a tetanic character some- 
times occur. The pupils are not always similarly affected. 
Taylor states that they are dilated. Percival speaks of it as 
differing from belladonna in contracting them ; also by the 
absence of delirium and of dryness of the throat. Wharton 
and Stille state that the pupils are but slightly affected. 

The external application of tobacco, either to the sound 
skin or to abraded surfaces, produces alarming and even 



604 TOXICOLOGY. 

fatal effects. A wet leaf put around the throat In spasmodic 
croup often relieves the spasm, but it should be used with 
great caution on a young child. A decoction applied to the 
skin of a man for an eruptive disease caused death in three 
hours. 

Its fatal effects, when administered by the rectum, are 
well known. It was formerly much used in this manner 
to aid the taxis in strangulated hernia, but it is always a 
dangerous remedy. Even tobacco smoke, diffused through 
water and swallowed, has caused the death of a young infant. 

Tobacco smoking has been known to produce violent and 
even fatal effects when carried to great excess, although 
there is considerable diversity of opinion as to whether 
nicotin is present in tobacco smoke or not. Authorities are 
found on both sides. 

The rapidity of the effects of tobacco on the human sys- 
tem varies with the dose and mode of administration. In 
one case snuff swallowed in whisky caused death in one 
hour. In another instance, quoted by Beck, an enema of 
tobacco, used to expel worms, produced violent convul- 
sions and death in fifteen minutes. Christison gives another 
case where a tobacco enema proved fatal in thirty-five min- 
utes. The application of nicotin to the tongue of an animal 
caused death within two minutes. 

Post-mortem Appearances. — There is no characteristic 
lesion. A diffused redness over the mucous surface of the 
stomach and bowels, with an empty heart and congestion 
of the vessels of the brain, liver and lungs, are about all 
that will be found. The blood is usually very dark and 
liquid. If the leaf or powder has been swallowed, these 
may be recognized by microscopic examination. In a case 
of suicide Taylor found general relaxation of the muscular 



NICOTIN. 605 

system, staring eyes, bloated and livid features, the vessels 
of the brain and scalp and also of the lnni2:s gorged with 
black blood, and the heart empty except its left auricle. 
There was intense congestion of the mucous membrane of 
the stomach and of the liver. The blood was liquid, and 
in some parts had the consistence of treacle. No peculiar 
odor was perceptible. 

Nicotin. — This alkaloid when pure is a colorless, oily 
liquid which, on exposure, becomes light yellowish and 
thicker in consistence. It produces a greasy, volatile stain 
on paper, like conin. It is usually said to possess an acrid, 
unpleasant odor, but if perfectly pure the smell is ethereal 
and agreeable. It has a strong, alkaline reaction and a 
density of i.oiii. It is freely soluble in water, alcohol, 
ether, chloroform, turpentine and the fixed oils. Ether 
and chloroform will extract it from its watery solution. Its 
taste is very pungent and acrid, even when much diluted, 
causing a peculiar sensation in the throat and air passages. 
It slowly distills at about 295° F., and boils at about 470° F. 
Heated on platinum it burns with a bright flame, emitting 
a thick black smoke. 

Nicotin is one of the most rapidly fatal poisons known, 
even rivaling prussic acid. A single drop destroyed a 
rabbit in three and a half minutes. In Wormley's experi- 
ments one drop placed in the mouth of a full-grown cat 
produced immediate prostration, continued convulsions, and 
death in seventy-eight seconds. 

In the celebrated case of Count Bocarme, who was exe- 
cuted in Belgium, 185 1, for poisoning his brother-in-law, 
Gustave Fougnies, nicotin was the agent used. An un- 
known quantity was forcibly put into the throat of the 



6o6 TOXICOLOGY. 

victim, the Countess assisting her husband as an accom- 
plice in the murder. Death was believed to have taken 
place within five minutes. The poison was detected by 
Stas in the tongue, throat, stomach, liver, and spleen of the 
deceased, and also from stains on the floor near where the 
act was committed. From the excellent report of the ex- 
amination of Stas, we may note the following particulars : 
The appearance of the tongue indicated the action of some 
highly acrid agent; it was swollen, blackened, softened 
and friable ; the epithelium was easily detached. This was 
also the condition of the mucous lining of the mouth and 
pharynx; it was reddened as if cauterized, and easily 
separated. The lining membrane of the stomach was in- 
tensely injected, exhibiting large patches which were livid 
and black. The vessels were filled with a black coagulum 
resembling blood that had been treated with sulphuric acid. 
The duodenum was also highly injected. There were no 
ulcerations or perforations of the stomach and bowels. The 
lungs were gorged with black blood and exhibited the usual 
character of asphyxia. The heart was normal ; its cavities 
contained black, liquid blood. No odor was observed in 
the body. 

Analytic Methods. — If a drop be put into a watch-glass, 
and this be covered with another glass inverted, containing 
a drop of either nitric or hydrochloric acid, the glass will 
become filled with white fumes, not so dense as from co- 
nin, nor do they give rise to the formation of crystals. 
The strong acids applied directly to it produce no charac- 
teristic effects. 

Nicotin unites freely with acids, forming salts, which do 
not readily crystallize, retaining the peculiar taste of the 
alkaloid, but are destitute of odor. They are mostly solu- 
ble in water and alcohol, but not in ether or chloroform. 



NICOTIN — ANALYTIC METHODS. 60/ 

1. Platinum chlorid throws down a yellow precipitate, 
which becomes crystalline seen under the microscope, and 
is soluble in hydrochloric acid. 

2. Mercuric chlorid gives a white crystalline precipitate, 
changing to yellow. These crystals assume a peculiar, 
beautiful appearance in groups of various patterns. These 
are distinguished from the precipitates caused by this same 
reagent witli ammonium hydroxid and the other alkaloids, 
by the fact that the latter are amorphous, except that of 
strychnin, but which last is wholly unlike that produced by 
nicotin. This is a very delicate test. 

3. Gold chlorid yields a yellow amorphous precipitate, 
which is not characteristic. 

4. Picric acid gives a yellow amorphous precipitate, 
which ultimately assumes the form of a crystalline tuft, to 
be viewed by the microscope. 

5. By adding to an ethereal, solution of nicotin a solution 
of iodin in ether, beautiful long, needle-like crystals form 
after some hours. 

Toxicologic Examination. — The stomach and other or- 
gans, properly prepared, may be subjected to the process of 
Stas. In fact, it was the process employed by its originator 
in the Bocarme case above alluded to. Other good authori- 
ties have somewhat simplified his process. Water may be 
employed as the solvent, instead of alcohol ; and either acetic, 
sulphuric, or tartaric acid may be used. After proper con- 
centration and filtration it should be supersaturated with 
sodium hydroxid and shaken up with chloroform or ether, 
and these solutions, when properly separated, allowed to 
evaporate spontaneously on watch-crystals, when the nico- 
tin, if present, will be seen in the form of drops or oily 
streaks, having the peculiar odor of the alkaloid, which is 



6o8 TOXICOLOGY. 

rendered more distinct by heating. This should be dis- 
solved in a few drops of water and the appropriate tests 
applied. A drop or two may also be given to a small 
animal. Nicotin inserted under the skin of a frog produces 
peculiar muscular movements, attended with tetanic con- 
vulsions, slowing of the heart's action, and of respiration. 

It causes death most probably by paralyzing the respira- 
tory nerve centers. 

Nicotin has been detected in the tissues several months 
after death. Wormley procured it from the blood of two 
cats, each poisoned by a drop placed upon the tongue, the 
animals having died in seventy-five seconds and in two and 
a half minutes, respectively. 

A ptomain has been described possessing many of the 
properties of nicotin, but it is not poisonous, nor does it 
respond to the usual tests of nicotin. 

Lobelia. — The Lobelia inflata, or Indian Tobacco, is a 
native of this country, belonging to the natural order 
Loheliacew. It is extensively used both here and in Great 
Britain in proprietary and domestic medicine. According 
to Letheby, thirteen cases of poisoning by this substance 
had occurred in England within three or four years, and 
Beck states that " thousands of individuals in the United 
States have been murdered by the combined use of capsi- 
cum and lobelia administered by the Thomsonian quacks." 
The leaves and seeds are the parts employed. They owe 
their activity to a fixed alkaloid named lobelin. 

Symptoms. — In small doses lobelia acts as an expec- 
torant, in large doses as an emetic and depressant. In 
poisonous doses it produces distressing nausea and vomit- 
ing, sometimes purging, extreme relaxation, cold sweats, 



LOBELIN. 609 

small, feeble pulse, great prostration, contracted pupils, 
stupor, occasionally convulsions, coma, and death — symp- 
toms strikingly like those caused by tobacco. A drachm 
of the powdered leaves has proved fatal. 

The post-mortem appearances are very similar to those 
caused by tobacco. 

Lobelin, the active alkaloid principle, is a yellowish liquid, 
lighter than water, of a somewhat aromatic odor, and acrid, 
persistent taste ; soluble in water, more so in alcohol and 
ether ; has an alkaline reaction, forming soluble salts with 
acids. Tannin precipitates it from its solutions. It resem- 
bles nicotin in most of its properties. On animals, lobelin 
seems to produce the narcotic, but not the emetic effects of 
the plant. 

No case is recorded of death from lobelin. In the inves- 
tigation of a case of death from lobelia the diagnosis would 
be materially aided by the discovery of fragments of the 
leaves or of the seeds. 

SPOTTED HEMLOCK. 

The Conium maculatum, or spotted hemlock, is believed 
to be the same plant as the Ciciita of the ancient Greeks, 
that furnished the poison by which Socrates perished. All 
parts are poisonous ; the leaves and root are employed in 
medicine, in the form of fresh juice and extract. It belongs 
to the natural order Umbellifcrcu, which also includes many 
other poisonous plants. The plant must not be confounded 
with the tree (hemlock spruce) common in the forests of 
northeastern United States. 

Poisoning by hemlock is generally the result of accident, 
the fresh leaves being used in soup in mistake for parsley, 



6lO TOXICOLOGY. 

which it somewhat resembles. Its action on man appears 
to be very variable — at least the accounts are very diverse. 

Symptoms. — Headache, imperfect vision, dilated pupils, 
difficulty of swallowing, drowsiness, a tingling sensation 
along the muscles, gradually complete paralysis of the ex- 
tremities ; this extends finally to the muscles of respiration, 
and the patient dies, at last, from apnea. If death be 
delayed for some time, there may be convulsions, coma, 
violent delirium, accompanied with salivation, and involun- 
tary discharges from the bladder and bowels. Death usually 
takes place in one to three hours. One drop of conin is 
considered to be a poisonous dose. The treatment consists 
in a prompt evacuation of the stomach by emetics or the 
use of the stomach-pump, followed by castor oil and stimu- 
lants. 

Post-mortem. Appearances. — These are not at all charac- 
teristic, redness of the mucous membrane of the stomach 
and conjestion of the lungs being usually observed. Frag- 
ments of the leaves and the seeds (if these have been swal- 
lowed) may often be recognized in the stomach and bowels 
with the aid of the microscope. If the leaves be rubbed in 
a mortar with sodium hydroxid, they emit a peculiar mousy 
odor. 

Conin. — This alkaloid exists most abundantly in the 
seeds. It is one of the most powerful and fatal poisons 
known. Christison states that a single drop, applied to the 
eye of a rabbit, killed it in nine minutes ; and three drops, 
applied in the same manner, killed a strong cat in a minute 
and a half. In Wormley's experiments, a single drop 
placed upon the tongue of a large cat caused the animal at 
first to stand still ; in two minutes and a half it fell upon its 



CONIN TESTS. 6ll 

side, voided nrine, had violent convulsions of the limbs, 
with trembling of the body, when it died in three minutes 
from the time of administration. 

Treatment. — Prompt emesis, to get rid of the poison, and 
active stimulation. Strychnin has been suggested as a 
physiological antidote, but it is too dangerous a substance 
to be employed for this purpose without excessive care. 

Properties. — Conin is a colorless, volatile, oily liquid ; sp. 
gr. 0.886; the odor is peculiar, repulsive, and suffocative. 
Diluted with water it emits an odor resembling mice. It 
gives a greasy stain to paper, and burns with a bright, 
smoky flame ; taste disagreeable and permanent. It is a 
strong base, forming with acids crystalline salts. Exposed 
to the air it becomes yellowish and resinoid. It is partially 
soluble in water, freely so in alcohol, ether, and chloroform ; 
the two latter will separate it from its aqueous solutions. 

Tests. — ^^A drop is placed in a watch-glass and covered 
over with a precisely similar glass, holding a drop of pure 
hydrochloric acid on its under surface ; both glasses imme- 
diately become filled with dense white fumes, and the drop 
of conin is converted into a mass of beautiful, delicate crys- 
talline needles, which do not deliquesce in the air. Sul- 
phuric acid imparts to it a pale-red color. Nitric acid 
causes with it dense white fumes. Strong hydrochloric 
acid imparts to it a faint tint, which gradually becomes 
much deeper, and on evaporation needle-shaped crystals 
appear. Like other alkaloids, it yields precipitates with 
tannin, mercuric chlorid, gold chlorid, platinum chlorid, 
potassium iodid, etc. By oxidation, conin is converted into 
butyric acid. A crystal of potassium dichromate is put 
into a test-tube with some diluted sulphuric acid, together 
with the suspected conin. On heating, the peculiar odor 



6 I 2 TOXICOLOGY. 

of butyric acid is revealed. Another test is alloxan. If 
dropped into a solution of this substance, an intense purple- 
red color is developed, and white needle-shaped crystals 
appear. Its liquid, oily condition, together with its peculiar 
odor, will distinguish it from all other bodies except nicotin ; 
and the points of difference between the two are mentioned 
in the article on nicotin. 

Toxicologic Examination. — Search first for any remains 
of leaves, or of seeds, in the stomach and intestines, and 
avoid mistaking the leaves of parsley for those of hemlock. 
Rub the leaves in a mortar with potassa, to develop the 
peculiar mousy smell. Then distill^ and examine the dis- 
tillate before employing the more elaborate process of Stas. 
Water and acetic acid may be employed as the proper sol- 
vents ; evaporate the filtered solution to a syrupy consist- 
ence, mix with strong alcohol and a few drops of acetic 
acid, filter again and evaporate tO' near dryness ; add a little 
distilled water, supersaturate with solution of sodium hy- 
droxid, and agitate with ether, repeating the process several 
times. Remove the ether and allow it to evaporate spon- 
taneously. Dilute the alkaloid and subject it to the appro- 
priate tests. 

A conin-like ptomain has been discovered, having very 
poisonous properties, but differing from conin in its reac- 
tions. 

It is necessary to guard against too much reliance upon 
the supposed odor of conin. Sodium hydroxid may often 
develop an odor from organic substances which might pos- 
sibly be mistaken for that of conin. Nothing short of the 
isolation of this principle, in a search for the poison, will be 
satisfactory. 

Other hemlocks, viz., Cicuta virosa, or water hemlock, 



ACONITE. 6 I 3 

and (Enanthc crocata, are all very poisonous ; this is espe- 
cially true of the CE. crocata, which is one of the most 
poisonous of the Umbcllifcnv. Children are occasionally 
poisoned by wild Umbelliferse, the exact species being fre- 
quently uncertain, partly because early growths of these 
plants rarely possess characteristic features, and partly 
because it is often impossible to secure specimens or clear 
descriptions of the plants eaten. The common parsnip, 
Pastinaca sativa, and even the common carrot, Daucits 
carota, are abundant in the wild state and are suspected of 
being more poisonous than in the cultivated forms. The 
tree known as hemlock (hemlock-spruce) has no botanical 
resemblance to water-hemlock and is not poisonous. 

ACONITE. 

Aconite. — The Aconitum napelhis (Monkshood or 
Wolfsbane) is indigenous in Europe, but is cultivated in 
this country. It grows from two to four or five feet high, 
and has a spike of rich blue flowers. All parts of it are 
poisonous, the root most so, depending on the presence of 
the alkaloid aconitin. The root is tapering, carrot-like, two 
or three inches long, having a number of curly fibers pass- 
ing off from it. This root has frequently been mistaken 
for the root of the horse-radish, from which, however, it 
differs essentially in appearance ; the latter being long and 
cylindrical and truncated, not tapering, of a light-brown 
color externally, white internally, and of a sweetish, hot, 
and pungent taste, totally distinct from that of aconite, 
which imparts to the lips, tongue, and fauces a peculiar 
tingling, numbing sensation, which is very persistent. 

There is considerable diversity in the activity of different 



OI4 TOXICOLOGY. 

Specimens of aconite, depending, doubtless, on the time and 
modes of collecting and drying of the plant, and probably 
also on the place of growth. This may account for the dis- 
cordant results obtained by different investigators. 

Aconite root has been administered criminally in at least 
one recorded case, where the powdered root was mixed 
with pepper, and sprinkled over the greens used for dinner 
by the deceased. 

Symptoms. — There is first a dryness of the throat, accom- 
panied with tingling and numbness of the lips, throat, and 
tongue, followed by nausea and vomiting, with pain and 
tenderness of the epigastrium. The numbness and tingling 
now become more general, with diminution or loss of sensi- 
bility of the surface, vertigo, dimness of vision, tinnitus 
aurium, with occasional deafness, frothing at the mouth, 
sense of constriction of the throat, great muscular prostra- 
tion, inability to walk, a slow, feeble pulse, difficulty of 
breathing, a cold, clammy skin, dilated pupils, features 
pale, perhaps a few convulsions, followed by death. The 
mind usually remains clear to the last. Delirium is rare. 
Death is apt to be sudden, either from shock, asphyxia, or 
syncope. 

Post-mortem Appearances. — There is nothing character- 
istic. There is usually general venous congestion of all the 
organs, especially the brain, lungs, and liver ; there may be 
redness of the lining membrane of the stomach ; the blood 
is generally fluid and dark in color ; the heart may continue 
beating for a little while after death, indicating that this was 
caused by asphyxia. In other cases the death may be as- 
scribed to syncope. 

The fatal dose is undetermined in consequence of the 
diversity in the strength of the different preparations of the 



ACONITIN. 615 

drug. An excise officer in England died in a few hours 
after merely tasting Fleming's strong tincture. Pereira 
speaks of a case in which two doses of six drops each of 
the tincture of the root, taken at an interval of two hours, 
produced most alarming symptoms in a young man ; and 
Wormley alludes to an instance in which five drops of 
Thayer's fluid extract of the root produced most serious 
eflfects, which continued for two hours. 

The symptoms may come on almost immediately or be 
delayed for an hour or two. Death generally occurs within 
three or four hours; but it may be deferred, as in other 
poisons, for twenty-four hours. 

Aconitin. — The active alkaloid principle, abounding most 
in the root, of which it constitutes about one tenth to one 
fifth of one per cent. It is one of the most powerful poisons 
known. Pereira states that one fiftieth of a grain nearly 
proved fatal to an elderly lady. Much of the aconitin as 
sold in the shops is totally inert and worthless. This poison 
has lately been brought prominently into notice in the case 
of Dr. Lamson, who used it in destroying his brother-in-law 
in England* some years ago. 

Treatment. — There is no active direct antidote. The 
stomach should be immediately emptied by the stomach- 
pump or an active emetic. Animal charcoal is recommended 
by Headland ; also tannin or astringent infusions. Slight 
galvanic shocks are recommended to be passed through the 
heart, in order to arouse its action ; also the employment of 
artificial respiration. Possibly the inhalation of oxygen 
might be of some advantage. 

As strychnin and aconitin seem to have some antagonistic 
action, it might be well to employ the former cautiously in 



6 I 6 TOXICOLOGY. 

the treatment of poisoning by the latter. A case has been 
reported in which the recovery of a child was apparently 
due to two doses of tincture of nux vomica, administered 
twenty minutes apart. 

It appears that digitalis may possess an antidotal power 
over aconitin. Fothergill discovered that digitalis, admin- 
istered to frogs that were under the influence of aconite, re- 
lieved the heart from the depression produced by the latter 
poison, recalling its normal movements. A case is reported 
in which recovery took place in a man who, when intoxi- 
cated, had swallowed an ounce of Fleming's tincture. The 
patient was apparently dying, when twenty minims of tinc- 
ture of digitalis were injected subcutaneously, and after 
twenty minutes the patient had recovered sufficiently to 
swallow, when a fluid drachm of the tincture was given, 
along with brandy and ammonium hydroxid, and was twice 
repeated within an hour. The above statement suggests 
the cautious employment of this remedy in a case of aconite 
poisoning. 

Analytic Methods. — Aconitin, when pure, is in colorless, 
transparent crystals, but as found in the shops it is usu- 
ally an amorphous powder. Many samples are inert. The 
taste is at first acrid, soon followed by tingling and numb- 
ness of the lips and tongue. Its solution, applied to the 
skin, occasions a feeling of heat and numbness. So active 
is this poison that, according to Stevenson, one three-thou- 
sandth of a grain of Morson's aconitin will destroy a mouse. 
The one thousandth of a grain produces tingling and numb- 
ness of the lips and tongue when applied to the tip of the 
latter organ; and one hundredth of a grain, dissolved in 
spirit and rubbed into the skin, causes a loss of feeling 
lasting for some time. 



CALABAR BEAN. 61/ 

It has Strong basic properties, forming salts with acids, 
which are mostly soluble. It is very slightly soluble in 
water, quite soluble in alcohol and chloroform, but insoluble 
in ether. None of the mineral acids changes it in the cold ; 
but warm sulphuric acid imparts to it a brown tint. There 
is no characteristic analytic test for it. Its presence can 
usually only be satisfactorily established by the physiologic 
test — the peculiar tingling, benumbing sensation imparted 
to the mouth and tongue when a minute fragment of the 
ultimate extract is tasted, or by a similar application to the 
skin, attended with similar results, together with its intro- 
duction into some small animal, hypodermically. 

If the poisoning has occurred from swallowing the leaves 
or root of the plant, a careful microscopic inspection of the 
stomach and bowels, and of the matters vomited and purged, 
should be instituted, in order to identify their botanical 
characters. 

Toxicologic Examination. — A hiodification of Stas' proc- 
ess should be employed, similar to that described for nicotin. 
Chloroform is preferable as the final solvent. The residue 
thus obtained should be dissolved in a few drops of pure 
water, slightly acidified with acetic acid, and submitted to 
the physiological tests above described. If these afford no 
satisfactory results, no mere analytic tests can be relied on ; 
but if they give evidence of the presence of the poison, then 
the solution should be subjected to all the known reactions, 
such as picric acid, platinum chlorid, gold chlorid, and the 

bromin test. 

CALABAR BEAN. 

The Ordeal Bean of Calabar (Physostigma venenosum) 
is a large leguminous seed, about an inch and a half long, 
and of a brownish-black color. It is used by the natives of 

53 



6 1 8 TOXICOLOGY. 

the West Coast of Africa as the ordeal test for witchcraft — 
the suspected person being compelled to drink a decoction 
of the poisonous beans. It owes its activity to the alkaloid 
eserin, also termed physostigmin, in the cotyledons. These, 
when touched with nitric acid, become orange, and with 
ferric chlorid brown. The alkaloid is a colorless, crystalline 
solid, bitter to the taste, very slightly soluble in water ; sol- 
uble in alcohol, ether, chloroform, and benzene. 

Bromin in potassium bromid produces with it a red color. 
It gives this color with less than y-oV-o" of a grain. Accord- 
ing to Dr. J. B. Edwards it reacts with sulphuric acid and 
potassium dichromate very much like strychnin — produc- 
ing the play of colors ; this, however, needs further confir- 
mation. 

The action of this poison upon the lower animals is that 
of a spinal depressant, causing at first tremors and then 
paralysis, with muscular flaccidity ; contraction of the pupils ; 
respiration slow, irregular, and stertorous ; sometimes there 
are convulsions. The heart is found to beat for some time 
after death. Consciousness is preserved throughout. 

The effects on man are similar to the above. They are 
the opposite to those produced by strychnin, which is a 
true spinal excitant. For this reason it has been employed 
as a remedy for tetanus, and also as an antidote for 
strychnin. 

Its most characteristic physiological action is the property 
of contracting the pupil, which at once distinguishes it from 
belladonna, as also from conin and curarin, which it resem- 
bles in some particulars. 

The true physiological antidote is atropin, used hypo- 
dermically, and repeated until expansion of the pupil is 
manifested. From the experiments of Dr. Fraser and 



LOBELIN. 619 

Others there can be no doubt of the mutual antagonism of 
atropin and eserin. 

The most satisfactory test is the physiological one — its 
power to contract the pupil. A drop or two of the sus- 
pected fluid is put into the eye of a rabbit or other small 
animal, and in the course of fifteen or twenty minutes the 
characteristic impression will be observed. 

Dragendorff has succeeded in separating it from the 
tissues by a modification of Stas' process, employing ben- 
zene instead of ether as the ultimate solvent. 

A boy, aged six years, died from eating six of the beans. 

HYDROCYANIC ACID. 

Hydrocyanic Acid (Hydrogen Cyanid, Prussic Acid) is 
one of the most energetic and rapidly fatal poisons known. 
It may be obtained from many plants of the order Rosacecc, 
such as bitter almonds, kernels of the peach, apricot, plum, 
and cherry, pips of apples, and the flowers and leaves of the 
peach and cherry-laurel. From the latter a very poisonous 
liquid is prepared. Hydrogen cyanid does not preexist in 
these vegetable substances, but is the product of the reac- 
tion, in the presence of water, of an unorganized ferment 
upon complex nitrogenous bodies. In the most familiar 
instance, that of the bitter almond, the result is due to the 
action of a ferment called synaptase upon a body called 
amygdalin. The process is quite analogous to ordinary 
digestion. Under the influence of the ferment, water is 
taken up by the amygdalin, which then decomposes into 
glucose, benzaldehyd and hydrogen cyanid. 

Hydrogen cyanid is a colorless, limpid liquid, extremely 
volatile, and having the odor recalling that of bitter almonds. 
A single drop placed upon the tongue of a large dog has 



620 TOXICOLOGY. 

caused death in a few seconds. The pure acid is rarely met 
with except in the laboratory. The dilute or medicinal acid 
is frequently the cause of death. This latter is merely a 
solution of the pure acid in water, and occurs in the shops 
under two different forms : ( i ) The official acid, of the 
average strength of two per cent.; and (2) Scheele's acid, 
of the average strength of five per cent. The strength of 
both varieties varies considerably, and it is not uncommon 
to find some specimens totally inert, probably from the 
liability of the acid to undergo decomposition when exposed 
to the light. The dilute acid is colorless, and has the odor 
of bitter almonds, and a hot, pungent taste. The French 
acid has a strength of ten per cent. 

Symptoms. — These vary with the size of the dose. A 
large dose — half an ounce to an ounce of the diluted acid — 
may produce symptoms in the act of swallowing, or in a 
few seconds after. They are seldom delayed beyond one 
or two minutes. Tardieu describes them as " coming with 
lightning-like rapidity." There is an immediate loss of 
muscular power with giddiness ; the person staggers and 
falls to the ground; the respiration becomes hurried and 
gasping; the pulse imperceptible; the eyes glassy and 
protruding ; the pupils dilated and insensible to light ; 
the extremities cold ; and sometimes convulsions occur. 
Toward the last the breathing is performed convulsively, in 
sobs. Sometimes the bladder and rectum are evacuated 
involuntarily. The face is pallid ; the jaws spasmodically 
closed ; there is frothing at the mouth, occasionally bloody ; 
often the peculiar odor of the poison can be detected in the 
breath ; death occurs sometimes in a violent convulsion, at 
others it is preceded by coma, with stertorous breathing. 
The last symptom is of considerable importance, since it 



HYDROCYANIC ACID — FATAL PERIOD. 621 

might easily lead to a mistaken diagnosis for apoplexy. In 
animals poisoned by this substance a peculiar cry is often 
heard, but this does not occur with human beings. 

Fatal Period. — Death generally occurs within ten or fif- 
teen minutes after swallowing the poison. Rarely is it 
protracted for half an hour. One case is recorded where 
an hour supervened. Insensibility is not, however, always 
immediate ; instances are recorded of persons, after swal- 
lowing very large and fatal doses of this poison, performing 
many voluntary acts, such as walking into another room, 
opening drawers, going down stairs, etc. 

The symptoms attendant on a large but not fatal dose 
are confusion of head, giddiness, a sense of weight upon the 
brain, great muscular debility, nausea, vomiting, possibly 
convulsions, and oppressed breathing. Several days may 
elapse before complete recovery takes place. 

Application to the skin, especially if abraded, may occa- 
sion fatal consequences. Christison reports a case in which 
the liquid, applied to a wound in the hand, caused death in 
one hour. 

Fatal Quantity. — The minimum fatal dose for an adult 
may be taken to be about fifty minims of the official prepa- 
ration, which is equivalent to nine tenths of a grain of anhy- 
drous acid. The largest dose from which a recovery has 
been reported was one drachm of Scheele's acid, equivalent 
to 2.4 grains of hydrogen cyanid. Other instances are re- 
ported of recovery after taking doses equivalent to two 
grains and under, in all of which prompt and vigorous 
measures were adopted. The inhalation of the vapor is 
exceedingly dangerous, and has even proved fatal. 

Treatment. — So rapid are the poisonous effects on the 
body that there is scarcely any opportunity for the employ- 



622 TOXICOLOGY. 

ment of remedies. The cold affusion, by dashing cold 
water over the face and chest, should be at once employed. 
This should be followed by the cautious inhalation of diluted 
ammonium hydroxid and chlorin, along with stimulants 
applied both internally and externally. As a chemical an- 
tidote, a mixture of ferrous and ferric sulphates, followed 
by a solution of potassium carbonate, has been proposed ; 
this would produce with hydrogen cyanid in the stomach 
Prussian blue — an inert compound. The experiment has 
proved successful with animals. Hydrogen dioxid (com- 
monly called hydrogen peroxid) decomposes cyanids com- 
pletely, but the action is too slow to be available in cases of 
poisoning. Cobalt compounds at once render cyanids inert, 
but these are themselves irritant poisons and are not ordi- 
narily obtainable. Still the poisonous action of a small 
amount of freshly precipitated cobalt hydroxid would prob- 
ably be slight and establishments in which cyanids are much 
used might keep on hand a solution of cobalt sulphate and 
sodium hydroxid, with directions for mixing and adminis- 
tering. 

Post-mortem Appearances. — The face is pale or livid ; the 
eyes often glistening and staring, with the pupils dilated ; 
the lips blue, jaws firmly set, with, at times, a bloody froth 
issuing from the mouth. The blood is of a dark blue color 
and fluid. The cerebral vessels are congested. Tardieu 
alludes to effusions of blood and serum at the base of the 
brain, as an occasional occurrence, which might suggest 
apoplexy ; this, however, is negatived by the absence of 
hemiplegia, and by the rapidity of the death. There is 
congestion of the lungs and liver ; and the mucous mem- 
brane of the stomach, especially about the cardiac ex- 
tremity, is apt to be much reddened. 



HYDROCYANIC ACID SILVER TEST. 623 

The exhalation of the pecuHar odor is one of the most 
important post-mortem characters. This odor is sometimes 
perceived even before the body is opened, in recent cases, 
but it is particularly noticeable in opening the abdomen and 
thorax, and even the brain, and especially the stomach. 
As the poison is very volatile, it may happen that the odor 
will have disappeared even in a few hours, if the body has 
been much exposed. There is a singular variation in this 
respect in different cases. Moreover, the odor may be dis- 
guised by other more powerful smells, such as tobacco, 
mint, etc. The mere absence of odor, is, therefore, no 
proof of the non-existence of the poison. 

Analytic Methods. — There are four recognized tests for 
hydrocyanic acid, which may be briefly designated as the 
silver, iron, sulphur, and copper tests. The first three are 
characteristic, and they may be applied either to the liquid 
or vapor. 

I. The Silver Test. — A solution of any cyanid gives, with 
a solution of silver nitrate, a white crystalline precipitate, 
distinguishable from the white chlorid, as follows : ( i ) By 
its crystalline characters (prisms or needles) ; the chlorid is 
amorphous. (2) Its sparing solubility in ammonium hy- 
droxid ; the chlorid is very soluble. (3) The permanence 
of its color when exposed to the light ; the chlorid becomes 
dark-colored. (4) Its solubility in boiling nitric acid; the 
chlorid is insoluble. (5) When perfectly dried, and heated 
in a small reduction-tube, the silver cyanid is decomposed, 
evolving cyanogen gas, which burns with a characteristic 
rosy flame. (6) By adding to the silver cyanid, hydro- 
chloric acid and ferric sulphate, Prussian blue will be 
formed. 

Another mode of identifying the silver cyanid, recom- 



624 TOXICOLOGY. 

mended by Orfila and Tardieu, is, after thoroughly washing 
and drying it, to introduce it into a small glass tube closed 
at one end, from five to seven inches long, and containing 
in its closed extremity a rather less quantity of pure iodin. 
On heating this end of the tube very gently, beautiful snow- 
white crystals of cyanogen iodid are deposited upon the 
cool portion of the tube. These crystals may be preserved 
indefinitely in sealed tubes ; and they may be used for de- 
veloping Prussian blue by dissolving them in a solution of 
sodium hydroxid, and adding a mixture of a ferrous and 
ferric salt. 

The silver test is particularly delicate when applied to 
the vapor. For this purpose the material containing the 
suspected poison is put into a beaker or wide-mouthed 
flask, and a watch-glass containing on its concave surface a 
drop or two of silver nitrate solution is inverted over the 
mouth of the flask, which should be gently heated by im- 
mersion in warm water. The vapor immediately arises, and 
coming in contact with the silver salt, forms a white, opaque 
spot of silver cyanid, which can easily be recognized by a 
lens and by the other tests mentioned above. If, however, 
the material should be in a state of putrefaction, this vapor- 
test cannot be applied, since the black silver sulphid result- 
ing from the hydrogen sulphid would completely obscure 
the white cyanid. 

The silver vapor-test is considered to be the most delicate 
of all the tests. It is stated that to""oV"o"o o^ ^ grain of the 
acid may thus be distinctly recognized. Guy mentions that 
a single apple pip, bruised and moistened with water, and 
placed in a watch-glass, over which was inverted another 
glass moistened with the silver solution, yielded twenty-two 
distinct reactions — each spot exhibiting, by the microscope, 
crystals of silver cyanid. 



HYDROCYANIC ACID TOXICOLOGIC EXAMINATION. 625 

2. The Iron Test. — This consists in adding to the sus- 
pected solution a little sodium hydroxid and then a mixture 
of ferrous and ferric sulphates ; a dirty greenish-blue pre- 
cipitate is thrown down, which, on addition of a few drops 
of pure hydrochloric acid, becomes Prussian blue. If the 
amount of the poison be very minute there is no immediate 
precipitate, although the solution has a blue (or at first, 
perhaps, a green) color; but in time a blue precipitate will 
subside. 

If the quantity is very small, it is recommended to throw 
the liquid upon a white paper filter after adding the hydro- 
chloric acid ; the blue deposit on the paper, after washing 
with very dilute acid, will show very distinctly upon the 
white ground ; the paper when dried may be preserved for 
exhibition, if needed. 

In manipulating with this test, caution should be used not 
to employ an excess of the reagents, as this materially inter- 
feres with the success of the experiment. 

The iron test may also be used as a vapor-test. Moisten 
the watch-glass with a drop of sodium hydroxid solution, 
and after exposure to the suspected vapors, add a drop or 
two of the mixed iron salts and develop the Prussian blue 
by a drop of dilute hydrochloric acid. 

3. The Sulphur Test. — If ammonium sulphid be added 
to a solution of any cyanid, and gently heated to dryness, 
a white ammonium thiocyanate is formed ; when this is 
touched with a drop of ferric chlorid there is instantly pro- 
duced the blood-red ferric thiocyanate. 

The sulphur test is best applied as a vapor-test. Moisten 

a watch-glass with a drop or two of ammonium sulphid and 

invert it over the vessel containing the substance to be 

tested, gently warming the latter as directed. The vapor 

54 



626 TOXICOLOGY. 

will rise and form the ammonium thiocyanate on the glass. 
When this is allowed to dry by evaporation it appears as a 
white spot, and when it is touched with a drop of the ferric 
salt it immediately assumes the characteristic blood-red 
color. If the evaporation should not have been complete 
so as to thoroughly dry it, the application of the iron salt 
may produce a black stain (iron sulphid), which will ob- 
scure the result. 

The sulphur test, moreover, may be applied to confirm 
the silver test. For this purpose the spot of silver cyanid 
should be moistened with a drop of ammonium sulphid, and, 
when thoroughly dried, touched with a drop of the iron 
salt. The characteristic blood-red color may be distin- 
guished in spite of the black sulphid with which it is 
associated. 

4. The Copper Test. — The liquid is first made slightly 
alkaline by sodium hydroxid and a dilute solution of copper 
sulphate is added; a greenish-white precipitate is thrown 
down which becomes nearly white on the addition of a little 
hydrochloric acid. 

This test may be used also as a vapor-test. The watch- 
glass is moistened with a drop of the copper solution made 
slightly alkaline, and, after exposure, a drop of dilute hydro- 
chloric acid is added. 

As regards the relative delicacy of the above tests, ex- 
periments show that for the liquid, the iron and sulphur 
tests exceed the silver test ; but when in the form of vapor, 
the latter far surpasses all the others. 

Toxicologic Examination. — The stomach, together with 
its contents, and other viscera (having first been carefully 
examined for the peculiar odor) should be distilled in a glass 
retort, at a moderate temperature, care being first taken to 



POTASSIUM CYANID — ANALYTIC METHODS. 62/ 

ascertain if the material is acid or alkaline. Unless dis- 
tinctly alkaline, no acid must be added, otherwise it will be 
impossible to determine whether the hydrogen cyanid found 
in the distillate was originally present in the free state, or 
whether it might not have resulted from the action of the 
acid used upon a cyanid, a ferrocyanid, or a thiocyanate 
that might have been present in the material. Of course, if 
potassium cyanid has been the poison employed, the con- 
tents of the stomach would give an alkaline reaction, in 
which case the addition of sulphuric, or some other acid, 
would be perfectly proper. A thiocyanate exists in the 
saliva. 

In the case of Dr. Paul Schoeppe, at Carlisle, Pa., in 
1868 and 1872, this point was brought out. The allegation 
at first was that the deceased (a woman aged fifty-four) had 
been poisoned by hydrogen cyanid. It was afterward con- 
tended, on the failure to establish this, that the death was 
due to a mixture of that and morphin. The analyst em- 
ployed the distillation process, along with sulphuric acid, 
and testified to his having only obtained faint traces of a 
cyanid. It was very justly contended that these " traces " 
of the poison could readily be accounted for by the faulty 
process employed in the analysis ; that it might be, in fact, 
the result of the action of the acid upon the thiocyanate of 
the saliva. Moreover, there was an entire absence of the 
characteristic symptoms of the alleged poison before death. 
At the second trial, the evidence of the prosecution com- 
pletely broke down, and the prisoner was acquitted. 

The source of the poison found in the distillate, when an 
acid is employed, may be determined by treating a portion 
of the original material with a few drops of hydrochloric 
acid, stirring the mixture for a short time, and adding ferric 



628 ' TOXICOLOGY. 

chlorid. If the liquid contains either a ferrocyanid or a 
thiocyanate, ^the former will be indicated by the formation 
of Prussian blue, and the latter by the red ferric thiocyanate ; 
whereas, a cyanid, such as potassium cyanid, will not give 
any reaction under the circumstances. 

As regards the question whether prussic acid can be 
generated by the distillation of putrescent animal matters, 
although Orfila appears to have inclined to this belief, it is 
not held by later authorities. Still, something more should 
be insisted on as proof of poisoning than the finding of 
" mere traces," since these might possibly be the result of 
some animal decomposition, brought about under condi- 
tions not yet perfectly understood. Especially should this 
be insisted on when the symptoms preceding death did not 
agree with those characteristics of the alleged poison. 

Period after Death when the Poison may he found. — On 
account of its volatility and ready decomposition all traces 
of the poison may disappear very shortly after death. Skill- 
ful analysts have failed to discover it in twenty-six hours 
after death, in some cases ; while in others it has been de- 
tected as late as twenty-three days after. 

The mere fact of putrefaction is no obstacle to its detec- 
tion, although in such a case it will not be discoverable 
either by distillation or by the vapor-tests. It may have all 
been converted into ammonium thiocyanate by the ammo- 
nium sulphid resulting from the putrefaction. In such a 
case the material should be rendered slightly alkaline, and 
then acted on by alcohol, which dissolves the thiocyanate ; 
filter and evaporate to dryness ; dissolve the residue in water, 
and test by a ferric salt. 

Potassium Cyanid. — This salt is employed in photog- 
raphy, electrotyping, and some mining operations, and is a 



STRYCHNIN — SYMPTOMS. 629 

frequent source of poisoning to artisans engaged in these 
employments. It is a powerful poison, causing death in 
doses under five grains. 

It is a white deliquescent solid, very soluble in water, 
less so in alcohol, the solution giving off the odor of 
hydrogen cyanid ; it has an alkaline reaction. 

The symptoms, post-mortem lesions and treatment, are 
similar to those described under hydrogen cyanid. 

Analytic Methods. — (i) It is decomposed by acids, hy- 
drogen cyanid being liberated, which is readily recognized. 
(2) It gives with silver nitrate silver cyanid. (3) The 
potassium is precipitated by tartaric acid and platinum 
chlorid. (4) The iron and copper tests may be used, with- 
out the sodium hydroxid. 

Organic mixtures should be rendered feebly acid with 
sulphuric acid and distilled. Hydrogen cyanid will be ob- 
tained in the distillate, and may be tested as indicated above. 
The caution as to the faint reactions due to cyanogen com- 
pounds normally present or not poisonous applies here also. 

Oil of Bitter Almonds. — This does not preexist in the 
bitter almond, but results from the reaction of water upon 
its amygdalin and synaptase. It is obtained by distillation 
of bitter almonds reduced to a pulp along with water. It 
contains a variable proportion of hydrogen cyanid and ben- 
zaldehyd. When entirely freed from the former, the oil is 
not a poison. 

Properties. — It has a light yellow color, pungent odor, 
and a bitter, aromatic taste. It is heavier than water, in 
which it is but slightly soluble ; soluble in alcohol and 
ether. It is highly poisonous. The liquid sold as essence 
of bitter almonds is a solution of this oil in alcohol ; it is a 
very dangerous substance for domestic use. 



630 TOXICOLOGY. 

The symptoms, post-mortem lesions and treatment, are 
the same as those described under the head of hydrocyanic 
acid. The fatal dose is about twenty drops. 

Cherry-Laurel Water, obtained by distilling a macera- 
tion of the leaves of the cherry-laurel {Prunus laurocera- 
sus) , contains a portion of an essential oil similar to the oil 
of bitter almonds. It owes its poisonous properties to the 
hydrogen cyanid. Cherry-laurel water has occasionally 
proved fatal. It is especially identified with the case of 
Donallen, who poisoned his brother-in-law, Sir Theodosius 
Broughton, in 1782. 

The seeds of the peach, apricot and cherry, when swal- 
lowed, have proved poisonous, especially to children. The 
symptoms are very similar to those produced by a moderate 
dose of hydrogen cyanid. 

Nitrobenzene, or Oil of Mirbane. — This substance is 
the product of the action of nitric acid on benzene. It is a 
pale yellow liquid, with a strong odor of bitter almonds. It 
is used in perfumery and confectionery as a cheap substitute 
for the oil of bitter almonds. It is a powerful narcotic, pro- 
ducing effects resembling those of hydrogen cyanid, al- 
though much slower in its operation, requiring four or five 
hours before death occurs, which is usually preceded by 
coma, as in apoplexy. This poison operates more rapidly 
and powerfully when inhaled in the form of vapor. 

In a fatal case it may generally be identified by its strong 
odor. 

Analytic Methods. — It is distinguished from the oil of 
bitter almonds, which it so closely resembles in smell, by 
pouring a few drops of each upon a plate and adding a drop 
of strong sulphuric acid ; the oil of bitter almonds acquires 
a rich crimson color, with a yellow border, while the nitro- 
benzene is not affected. 



STRYCHNIN — CLOR TEST. 63 I 

It gives none of the reactions of hydrogen cyanid. 

When associated with organic substances, as the stomach, 
etc., it may be separated by first adding sulphuric acid and 
distilhng. 

If nitrobenzene be dissolved in alcohol and heated with 
hydrochloric acid and granulated zinc for some time, anilin 
will be formed. If the solution be filtered through a filter 
wetted with a solution of sodium hydroxid, the filtrate nearly 
neutralized with the same substance, and a dilute solution of 
chlorated soda, or bleaching powder, be added, any anilin 
present will produce a violet color. The test is delicate, buf 
requires careful manipulation. 

Several fatal cases of poisoning by nitrobenzene and 
anilin contained in shoe-polish have been reported. These 
are the recently introduced forms that are applied liberally 
with a brush. Nitrobenzene and anilin are used as solvents 
for the other materials. 

A case of fatal poisoning of this type was reported by 
Dr. W. J. Stone, of Toledo, O. (/. Amer. Med. A., Oct. i, 
1904). The clinical history was furnished by Dr. A. W. 
Wheeler, attending physician and Dr. P. Donnelly, con- 
sultant. Mr. G. A. Kirchmaier made a chemical analysis 
of the portion of the polish, and also of some of the polish 
on the shoes worn by the patient and found nitrobenzene in 
both. It would appear from the report that the possibility 
of the coincident presence of anilin was not ascertained. In 
some of the cases reported in Europe, the polish has been 
stated to contain notable amounts of anilin. The following 
is an abstract of the above case : 

A man, aged 22, wore low shoes with cloth tops. In 
polishing them he stained the cloth portion liberally and 
some of the material passed through, staining his ankles. 



632 TOXICOLOGY. 

He was was taken suddenly ill about 12 130 A. M. He had 
attended a dancing party earlier in the evening in company 
with some friends. After the party he and four or five of 
his associates took lunch. He remarked that he did not feel 
well, but his friends noticed only that he was pale. While 
standing up to put on his coat, which one of the men pres- 
ent was holding for him, he suddenly fell to the floor. He 
complained of no pain, but felt dizzy and faint, and shortly 
after vomited beer, crackers and cheese eaten but a few 
moments before. Dr. Wheeler was not called until about 
'3 130 A. M., since the roommate supposed the man to be in 
a drunken stupor. He had passed into the comatose condi- 
tion on arrival at his room about 2 A. M., and had not re- 
covered from it. He was in collapse ; very pale skin, eyes 
glazed, cyanotic lips^ ears and finger tips, corneal reflexes 
absent, no peculiar odor to breath, no convulsive tendencies, 
heart action fairly good, both sounds clear, pulse rapid, 130, 
skipping about one beat in 25, respiration 28. 

The report states that Dr. Wheeler administered " -3^ 
strychnin and yV apomorphin." Presumably these were 
given hypodermically, the amounts being fractions of a 
grain, strychnin sulphate and apomorphin hydrochlorid 
being meant, but these important data are not given in the 
report. This treatment was without favorable result. 
Shortly after the arrival of the consultant (4.45 A. M.), a 
slight convulsion occurred, the left pupil dilated suddenly, 
the heart beats became inappreciable and after feeble re- 
spiratory efforts for about five minutes, the man died, about 
four and a half hours after the fainting in the lunch room. 

The post-mortem was made with great thoroughness, for 
the details of which reference must be to the original paper. 
The principal lesion was marked acute desquamative 
nephritis. 



SYNTHETIC COAL-TAR PRODUCTS. 633 

Anilin, which is a derivative of nitrobenzene, has decid- 
edly poisonous properties. Persons engaged in its manu- 
facture or use are subject to giddiness and headache, and 
frequently exhibit a cyanosed condition of the face and lips. 
Epileptiform convulsions and insensibility also occur in the 
more serious cases. Acute poisoning in the human subject 
is almost unknown. In animals the principal symptom is 
loss of muscular power and coordination. There is no 
specific antidote. Anilin can be recognized by the produc- 
tion of a violet color with chlorated soda solution, as noted 
under nitrobenzene, the preliminary treatment with hydro- 
chloric acid and zinc being omitted. 

Anilin Colors, under which term are also included numer- 
ous artificial colors made from coal-tar derivatives other 
than anilin, are, as far as known, not poisonous in the ordi- 
nary sense ; that is, do not produce distinct symptoms in 
moderate doses. Some of them are contaminated with poi- 
sonous accessory or by-products, such as arsenic, lead, tin, 
and copper. Many of the published experiments on the 
action of anilin colors when injected into the bodies of ani- 
mals are without value, in consequence of antiseptic precau- 
tions not being observed. 

Synthetic Coal-tar Products. — Within the past twenty 
years many substances prepared artificially from coal-tar 
products have been employed largely for the treatment of 
nervous affections, especially neuralgias. Antipyrin and 
phenacetin are well-known examples. The so-called " head- 
ache cures " contain generally acetanilid (often called anti- 
febrin), caffein, sodium carbonate or ammonium carbonate. 

Poisoning by these agents usually exhibits feeble, slow 
pulse, subnormal temperature, cyanosis, and shallow respi- 



634 TOXICOLOGY. 

ration, but nausea and severe vomiting or deep insensibility 
are sometimes seen. The symptoms are probably much in- 
fluenced by idiosyncrasy, and incidental conditions of the 
system. There is also a considerable amount of substitu- 
tion, surreptitiously, of these drugs, so that unexpected 
effects are produced. The treatment consists in washing 
out the stomach, applying warm applications externally to 
restore temperature and using stimulants such as alcohol, 
coffee and strychnin internally. The following notes of re- 
cently reported cases will show the general effects. The 
first is a case of poisoning by trional, the second by 
acetanilid. 

1. In this case the patient was a woman aged twenty-eight 
years. There were well-marked hallucinations of the para- 
noic type. The symptoms usually seen in such poisoning 
were also observed, namely, dizziness, staggering, loss of 
the reflexes, deep respiration and hematoporphyrinuria. 
The last-named symptom appeared late in the case, although 
it is usually early. The patient had an abnormally small 
heart and her previous condition was such as to lead to 
considerable loss of weight, which may have caused special 
susceptibility to the poison. The patient succumbed to the 
poison, and the post-mortem showed no lesions that could 
account for the death. 

2. The patient, a man, took 60 grains of acetanilid 
within a few hours for headache. He became delirious, 
feverish, somewhat jaundiced and complained of headache 
and pain in the umbilical region. There was hyperesthesia 
with increased reflexes, persistent vomiting, so that nourish- 
ment could only be carried on by the rectum ; weak pulse, 
shallow respiration, subnormal temperature and continuous 
falling off in the number of red blood cells with leukocytosis, 



NITROBENZENE. 635 

The urine contained hematoporphyrin but in the latter stage 
of the case complete suppression occurred. He died on the 
eighth day, the final condition being acute nephritis, intesti- 
nal hemorrhage and jaundice. 

The extensive sale of headache powders containing ace- 
tanilid (which is used to the exclusion of phenacetin or 
antipyrin on account of the lower cost) has resulted not 
only in acute poisoning, but in numerous cases of cumu- 
lative, or, as commonly called, chronic poisoning. Dr. 
Stengel has reported several carefully observed cases of 
this type. Among the interesting phenomena connected 
with the three cases which he saw was the denial by the 
patients that they had used the drug, though it was ulti- 
mately acknowledged in each case. He thinks this may be 
due to not merely a fear that the drug may be promptly 
withdrawn but to a moral disturbance. The following is a 
summary of the report of one of the cases. For the full 
data, which are given with much care and in detail, refer- 
ence must be made to the original paper (/. Amer. Med. A., 
July 22, 1905). 

A man, aged 38, strongly built, well-nourished. The face, 
lips and finger nails were deeply cyanosed, but the surface 
was not specially cold. There was marked pulsation of the 
vessels of the neck ; pulse rate 85, and on slight exertion 
reached 105 or no. The heart was enlarged, the left border 
extending beyond the midclavicular line and the right border 
a little beyond the right edge of the sternum. The action 
was irregular and the apex impulse diffuse. On ausculta- 
tion the sounds were found to be somewhat indistinct and 
vibrating in quality, but no murmur. Lungs were negative. 
Abdominal organs were apparently normal. The spleen 
was not palpable. 



636 TOXICOLOGY. 

The knee jerks and other reflexes normal. The eyes were 
a Uttle prominent, but otherwise normal. There was a 
slight tremor of the hands. The thyroid gland was not en- 
larged. 

The urine was dark and showed a considerable amount 
of indican, but was otherwise negative. Subsequently it 
improved and repeated examinations showed no abnormali- 
ties in color or in other appearances. 

Repeated examinations of the blood were made, which 
showed always marked polycythemia, the number of red 
corpuscles being 6,000,000 or greater. There was no excess 
of leucocytes. Histologic examinations showed no abnor- 
malities in the erythrocytes except an apparent enlargement. 
Nucleated red cells were never found, and basic granula- 
tions and polychromatophilia were absent. 

He had for some time taken an acetanilid proprietary 
remedy for facial neuralgia and headaches. The amount 
could not be determined, as he carried it about and took 
doses at irregular intervals and without any care to avoid 
excess. The blueness of the skin was of about a year's dura- 
tion, which agreed with the time during which the remedy 
had been taken. 

The treatment consisted in discontinuing the acetanilid 
and administering tonics, with iron, arsenic and cardiac 
stimulants. Under this the patient became well in a few 
months. 

The following are some special notes in the clinical chem- 
istry of another case reported in the same paper. The 
urinary examinations were made by Dr. Fife. The urine 
amounted in twenty-four hours to 680 c.c. ; sp. gr., 1022 ; 
acid, volatile fatty acids equal 51.6 c.c. of o.i normal acid 
solution. No acetone, no phenol. Tests for blood and bile 



NITROBENZENE. 637 

pigments negative. Heller's test for urophcin positive ; 
Harley's test for iirohematin negative. No urobilin. In- 
dican excessive in amount. Both the indoxyl sulphates and 
indoxyl glycuronate were indicated by Strauss' test. 

At a later period, some doubt having been cast on the con- 
clusion that acetanilid alone had caused the symptoms, and 
the patient having denied the taking of any acetanilid be- 
tween her first and second visit to the hospital, the drug 
was administered in doses increasing from 20 to 45 grains 
daily, resulting in a progressive increase in cyanosis and 
a return of the dark color of the urine. The chemical ex- 
amination, however, again showed the absence of blood 
pigments. A few days afterward the urine amounted in 
twenty-four hours to 600 c.c. dark reddish brown color, acid 
reaction, color becoming brown wine-red on addition of an 
alkali. This was probably due to paramidophenol, a deriva- 
tive of acetanilid. Excessive amount of both indoxyl sul- 
phate and glycuronate. Ethereal sulphates, 0.3769; pre- 
formed sulphates, i .044, both calculated as sulphuric acid ; 
total nitrogen, 9.4 grms. The indophenol reaction of para- 
midophenol present in ethereal extract (Jafife method). 
Oxycarbamid not demonstrated. No blood pigments pres- 
ent. The high color is probably due to paramidophenol and 
possibly in part to substances derived from the indican. 
Blood serum obtained by puncture of a vein with a hollow 
needle was distinctly colored, but on spectroscopic examina- 
tion showed only the absorption bands of oxyhemoglobin. 
When treated with ammonium sulphid and with Stokes 
ferrous tartrate solution, it exhibited the band of reduced 
hemoglobin. Examination of the blood showed some 
nucleated red corpuscles, poikilocytes and irregularity in 
the affinity for stains. 



638 TOXICOLOGY. 

In this connection it is worth noting that acetanilid is 
sometimes used as an adulterant for vaniUin, the flavoring 
principle of the vanilla bean. 

DIGITALIS. 

The purple Foxglove (Digitalis purpurea) is a native of 
Europe, but cultivated in our gardens. All parts of the 
plant contain several active principles, of which the most 
important are digitalin, digitoxin, digitonin, and digitalein. 
These are glucosids, not alkaloids. 

The chief poisonous principles are digitalin and digitoxin, 
which always accompany each other in the plant. 

Symptoms. — Cases of digitalis poisoning are compara- 
tively rare. Until recently, its action was generally re- 
garded as a direct cardiac depressant, reducing both the 
force and frequency of the heart's action. Therapeutists 
are now disposed to consider it as a direct heart stimulant, 
asserting that while the pulsations of the heart are dimin- 
ished in frequency they are increased in power. 

The poisonous impressions on man are nausea and vom- 
iting, purging, with severe abdominal pains, a sense of heat 
in the head, vertigo, disordered vision, and dilated pupils ; 
the pulse full and slow in the horizontal position, but rapid 
and feeble on sitting up. Prostration then comes on, with 
a tendency to syncope ; the eyes very prominent and fixed, 
the sclerotic coat acquiring, according to Tardieu, a pecu- 
liar, characteristic blue color. Sometimes there is saliva- 
tion and suppression of urine ; delirium, stupor, and con- 
vulsions are apt to come on just before death, which does 
not, as a rule, occur within twenty-four hours. Tardieu 
mentions a case in which death took place in three quar- 
ters of an hour after swallowing, by mistake, a very large 
dose. 



DIdlTALlN. 639 

Digitalis seems to have a tendency to break out with 
violence after taking a number of moderate doses. The 
diagnostic sign of the action of digitalis is the peculiar 
enfeebled, intermittent pulse, which varies so notably be- 
tween the supine and the erect position of the patient. 

Post-mortem Appearances. — Nothing very characteristic 
is observed. Turgescence of the vessels at the base of the 
brain, together with redness of the lining membrane of the 
stomach, has been noted. 

Fatal Dose. — This is not accurately settled. As much 
as a drachm of the powder, and half a fluidounce of the 
tincture have been taken with impunity ; but a far less 
quantity has produced decided effects on the heart's action. 
The usual dose is one to two grains of the powder, and ten 
drops of the tincture, to be repeated. 

Digitalin. — This generally occurs as an amorphous pow- 
der of a pale yellowish color ; but when pure, in fine white 
crystals. There seems to be much diversity of opinion con- 
cerning the percentage of digitalin in the leaves, some au- 
thorities giving it at about ten per cent., whilst Blaquart 
asserts that there are ten to twelve per cent, of the crystal- 
lizable variety. 

There seems to be a true antagonism between digitalin 
and aconitin. It is stated that when the heart of the frog 
has almost ceased to beat under the influence of digitalin, 
its movements are restored by aconitin; and a case is re- 
ported of recovery after the ingestion of an ounce of 
Fleming's tincture of aconite, apparently due to the hypo- 
dermic injection of twenty minims of tincture of digitalis, 
and the exhibition by the mouth of three doses of one 
drachm each, within an hour, together with brandy and 
ammonium hydroxid. 



640 TOXICOLOGY. 

Analytic Methods. — Both the amorphous and crystalline 
varieties have a very bitter taste; very sparingly soluble in 
water, also' in pure ether, but very soluble in ether contain- 
ing alcohol. Chloroform is its best solvent. It has no 
alkaline reaction. Cold sulphuric acid imparts to it a brown- 
ish color, which gradually changes to a red. If warmed, 
the color passes to a brown. If to the cold brown solution 
an excess of water be added, the color changes to a green, 
depositing a green powder, and the liquid gradually assumes 
a yellowish tint (Tardieu). Strong nitric acid dissolves it 
with effervescence, giving off red fumes, and imparting an 
orange-red color, which gradually becomes fainter. Hydro- 
chloric acid imparts to it a light greenish tint. It is stated 
that if the brown sulphuric acid solution be exposed to 
bromin vapor it assumes a violet hue, but Tardieu denies 
that this test is at all characteristic. 

Toxicologic Examination. — In a suspected case the ex- 
aminer should first carefully search for fragments of the 
powdered leaves in the matters vomited and in the alimen- 
tary canal. If the tincture has been swallowed, the interior 
of the stomach might present a greenish color and emit a 
suggestive odor. If digitalin granules have been taken, a 
careful post-mortem inspection might possibly reveal the 
presence of some of them remaining in the stomach. 

The viscera, properly comminuted, should first be heated 
on a water-bath with strong alcohol for a considerable time. 
After cooling and straining and proper concentration by 
evaporation, part of the extract may be used as a trial test 
on a small animal. The rest of it should be further puri- 
fied by another solution in alcohol, filtration and evapora- 
tion, and the physiologic test again repeated. 

It is impossible to determine positively the existence of 



DIGITALIN — TOXICOLOGIC EXAMINATION. 64 I 

the poison by any chemical tests, nor by the post-mortem 
lesions ; our reliance must be solely on the physiologic 
test — injecting hypodermically some of the ultimate extract 
into a small animal, as the frog. It seems well established 
by numerous experiments that death takes place by a sud- 
den cessation of the heart's action, with a decided rigidity 
of the ventricles at the moment of death. In frogs this 
stoppage occurs always in the state of strong systole of the 
ventricle. 

By observing, then, the action of the suspected poison 
introduced under the skin of the frog, the gradual irregu- 
larity and slowness of the heart beats, together with the 
manner of its final stop, and experimenting at the same 
time with digitalin itself upon another animal, we may be 
able to arrive at a satisfactory conclusion. 

The most noted, if not the only instance, of homicidal 
poisoning by digitalin is that of de la Pomerais, a homeo- 
pathic practitioner of France, who was tried and convicted 
for killing his mistress after having insured her life in vari- 
ous officers for his own benefit. After one of his visits 
to her she died, after suffering from violent vomiting and 
great depression of the heart's action and debility, in twenty- 
four hours. Her body was examined thirteen days after 
death, suspicion having been aroused against the prisoner. 
The examiners, Tardieu and Roussin, failing to discover 
any poison by chemical research, resorted to the above- 
mentioned physiologic test, employing the extract obtained 
from the stomach and bowels and also one procured from 
the scrapings of the floor on which the deceased had vom- 
ited, both of which responded likewise to all the known 
chemical reactions. A strong circumstantial evidence of 
the guilt of the accused was the finding in his possession 

55 



642 TOXICOLOGY. 

of an unusually large amount of digitalin, a substance that 
had only lately been discovered, besides a number of other 
deadly poisons. He was condemned and executed. 

Poisoning by Cocculus Indicus. — Cocculus Indicus {Le- 
vant nut) is the fruit of the Menispertnum cocculus, a tree 
growing in the East Indies. The kernel of the berry is the 
only poisonous part. It has an intensely bitter taste, and 
contains a highly poisonous principle called picrotoxin. It 
is chiefly employed as a fish poison and sometimes for the 
malicious destruction of game. It is popularly believed to 
be used for adulterating malt liquors, by imparting to them 
a bitter flavor and increased intoxicating powers, but this 
must be unusual. It is also used for the destruction of 
vermin. 

The symptoms are ^ somewhat singular, indicating an 
action on the cerebro-spinal centers. There is loss of vol- 
untary power, but not of consciousness, the sufferer lying 
in a sort of nightmare. There may also be nausea, vomit- 
ing and severe abdominal pains. Dr. Fish reported cases 
of accidental poisoning of six persons in the Philadelphia 
Hospital by a decoction of this substance. Two of these 
died in about half an hour ; the remaining four were seized 
with violent symptoms within half an hour after swallowing 
the poison, and recovered after several hours. Their symp- 
toms were faintness, confusion of mind, giddiness, dimness 
of vision, nausea, excessive thirst, severe abdominal pain, 
and, in one case, insensibility; the pulse was much weak- 
ened and the respiration slow and labored. 

The external application has been followed by violent 
and even fatal effects. 

Picrotoxin constitutes about one per cent, of the kernel. 



COCCULUS INDICUS — POISONOUS GASES. 643 

It crystallizes in colorless, silken, slender, four-sided prisms ; 
sparingly soluble in water, very soluble in alcohol, ether, 
chloroform, and amylic alcohol. Cold sulphuric acid does 
not affect it ; the hot acid imparts to it an orange-yellow 
color, which becomes pale on cooling. Strong nitric acid 
and hydrochloric acid do not affect it. It acts like grape 
sugar when boiled with copper sulphate and sodium hy- 
droxid. 

It may be separated from organic liquids by first acidu- 
lating with hydrochloric acid and then shaking up with 
ether, which holds the poison in solution and deposits it in 
crystals. 

There are several other vegetable poisons of minor im- 
portance ; among them may be mentioned the bark and 
seeds of the Laburnum (Cytisus laburnum) , a very common 
tree or shrub of Great Britain. It contains an active poi- 
sonous alkaline principle, cytisin, whose effects are those of 
an irritant narcotic. Death has frequently resulted from 
swallowing both the bark and seeds of this plant. 

The leaves and berries of the Yew {Taxus haccata) act 
powerfully as an acrid, irritant narcotic, even in small quan- 
tities. They owe their poisonous properties to an alkaloidal 
principle which destroys life by paralyzing the respiratory 
center. 

The Privet (Ligustriim vulgare), the Guelder Rose {Vi- 
burnum opulus), and the Holly {Ilex aquifolium) also pos- 
sess poisonous properties. 

Poisonous Gases. — Most poisonous gases are so irritat- 
ing to the mucous membrane of the trachea, that they cannot 
be inhaled without producing spasm of the glottis and suffo- 
cation. Some that are not irritating are so offensive in odor 
as to give prompt warning of their presence in appreciable 



644 TOXICOLOGY. 

amount in the air. Two common gases possess neither of 
these properties, and are Hable to cause poisoning. These 
are carbon dioxid and carbon monoxid. 

Carbon dioxid is the principal product of ordinary com- 
bustion, and when present in air in small amount does not, 
so far as is known, do' any harm. In large proportion it 
produces simple suffocation. It is without odor or irritant 
action. The individual exposed to it simply becomes 
promptly unconscious, but if immediately removed to pure 
air and treated with surface stimulation and artificial res- 
piration may recover and no abnormal condition result. 
Such cases often occur in mines, sewers and in industrial 
establishments, for instance, brewing, in which much carbon 
dioxid is liberated. In 1904 several workmen engaged in 
unloadmg the steamship Switzerland, at Philadelphia from 
Antwerp, were overcome on entering the lower hold which 
had just been opened after a voyage of about ten days. One 
man could not be got out for several minutes and per- 
ished, but others were removed in time. Some of them were 
taken to a hospital but recovered without difficulty. For 
the general symptoms and treatment carbon dioxid poison- 
ing see under *' Suffocation." 

Carbon monoxid, sometimes called carbonic oxid, is 
produced when carbon is burned in a deficient supply of 
air. It is, therefore, formed when stoves are charged with 
fuel and operated with partial draft. It probably escapes 
constantly into the air of furnace-heated houses. The ex- 
tensive use of water gas is also a source of danger. Water- 
gas is made by the action of steam on red-hot coal. It con- 
sists principally of hydrogen and carbon monoxid. Many 
cases of fatal poisoning by accident or suicide are now oc- 
curring in American cities. The characteristic effect of 



PTOMAINS. 645 

the gas is combination with hemoglobin by which the power 
of the blood corpuscle as an oxygen carrier is abolished, 
since the compound (carbon-monoxid-hemoglobin) is not 
broken up by the oxygen of the air. The effect is therefore 
cumulative. A small amount of carbon monoxid in the air 
will, by constant inhalation, destroy the function of many 
corpuscles, producing a chemical asphyxia, which will not 
yield to artificial respiration. The symptoms are marked 
muscular weakness, flushed face and sleepiness. The blood 
becomes bright red, the breathing stertorous. If the person 
be rescued from the incipient condition, recovery may slowly 
take place, but often death results after half a day or so, or 
a chronic condition may be established which results in 
death much later. The blood resists putrefaction to a strik- 
ing degree. Treatment is unsatisfactory. Ordinary meas- 
ures, such as artificial respiration, stimulation, externally and 
internally, do not succeed. Transfusion of blood has given 
good results in animal experimentation. Good results have 
also been claimed for the administration of hydrogen dioxid 
by the stomach and hypodermically, but this is doubtful. 

Many cases of chronic poisoning by carbon monoxid have 
been observed in Europe, produced by the constant presence 
of minute amounts of the gas in the air. The principal 
symptoms reported are digestive disturbances, muscular 
weakness, headache, and a striking hebetude. Anemia of a 
pronounced type is also observed. 

PTOMAINS. 

Within the past quarter century the attention of toxi- 
cologists has been actively drawn to the existence of a cer- 
tain class of bodies, to which Selmi gave the name of 
Ptomnins (from TZTajfia, a dead body), resulting from the 



646 TOXICOLOGY. 

decay of organic substances. Many of these resemble the 
alkaloids in their chemic and physiologic actions. Some 
of them are very poisonous, others are inert, and others 
again seem to be antagonistic to some common poisons. 

It has long been known that putrescent meat will occa- 
sion severe and sometimes fatal symptoms in persons who 
partake of it. These symptoms are of" a narcoto-irritant 
character and strongly resemble those produced by certain 
familiar poisons. Similar effects are also known to occa- 
sionally result from cheese, sausages, and certain shell-fish, 
particularly from mussels, and, in some instances, from 
canned meat and vegetables. These anomalous symptoms 
have formerly been attributed to various causes, but hitherto 
no satisfactory explanation of them has ever been offered 
until the discovery of the ptomains has solved the mystery 
and afforded a rational and scientific solution. 

It is now known that putrefaction is due to the presence 
of microbes, which, when introduced into the animal body, 
may speedily develop serious and even fatal disease. This 
fact affords a satisfactory explanation of those otherwise 
obscure cases of poisoning that occasionally result from 
partaking of certain articles of food, such as canned provi- 
sions, milk, ice-cream, sausage, cheese, etc., which have 
undergone unsuspected putrefaction. 

Many ptomains have been isolated, and the discoyery has 
opened a new field of investigation in physiologic chemistry. 
Some ptomains bear a strong resemblance to some of the 
vegetable alkaloids in both chemical and physiologic reac- 
tions; and as they may generate by putrefaction in the 
human viscera, it may readily happen to the analyst to 
encounter one of these ptomains in searching for strychnin, 
morphin, nicotin, etc., in a putrescent human body. For- 



PTO MAINS. 647 

tiinately the ptomains occurring under the above conditions 
are not always met with ; moreover, the expert, with proper 
precaution, will be able to discriminate between them and 
the true alkaloids from the fact that, although they have 
many points in common, there exist reactions, both chemic 
and physiologic, in which they differ. 

Another point in this connection that should not be over- 
looked by the toxicologist is the fact that the presence of 
one or more of these ptomains, along with certain of the 
vegetable alkaloids, in a dead body may interfere with the 
usual chemical tests employed for the detection of the latter 
poison. This is true, to some extent, in the case of strych- 
nin, brucin, atropin, aconitin, picrotoxin, and a few others ; 
but this subject has not received sufficiently full attention to 
enable us to speak very positively about it. Ranke contends 
that the proper physiologic action of the impure strychnin 
extracted from a putrefied body may be masked by ptomains. 
If this observation, as also those above mentioned, is correct, 
it may explain the occasional failure to discover strychnin 
and other alkaloids in a putrescent body. 

Selmi and others have succeeded in extracting poisonous 
bases from the urine of patients suffering from tetanus, pro- 
gressive paralysis, and miliary fever ; one of these resembled 
nicotin in its general character, showing a special tendency 
to act upon the spinal marrow and heart ; the other base 
resembled conin in odor. 

Still later researches go to prove that animal fluids, such 
as fresh blood and albumin, before undergoing putrefaction, 
give precisely similar reactions, with the reagents employed, 
to those that are afforded by these same reagents with 
ptomains extracted from a dead animal body. 

It will be inferred from all that has been stated upon this 



648 TOXICOLOGY. 

subject that the whole matter concerning ptomains may be 
regarded as being, to a considerable extent, still sub judice; 
and the existence of these cadaveric alkaloids in human vis- 
cera, even when putrid, is probably not of such frequent 
occurrence as was suspected. Nevertheless, it cannot be 
doubted that their alleged existence will be constantly 
brought out in trials. Such a course is stated to have been 
taken at the Lamson trial, in London, in 1883. On the 
other hand, it might be speciously argued that the reason 
for the non-discovery of the alleged alkaloid was to be 
attributed to the interfering presence of some ptomain. 

Much light has been thrown upon the relations of the 
ptomains in toxicologic chemistry by the investigations 
of Vaughan. Ordinary putrefactions are aerobic — that is, 
take place under the influence of free oxygen. Laboratory 
studies of decompositions^ either in culture fluids or in 
ordinary foods, have been, therefore, largely limited to one 
class of actions — those of microbes which grow in the 
presence of oxygen. It is now known, however, that not 
only are there several species of microbes which grow only 
in the absence of oxygen, but some of those ordinarily grow- 
ing in contact with oxygen can grow in its absence, pro- 
ducing substances different from those formed under normal 
growth. In buried corpses the decompositions will be at 
low temperatures, and with at least very deficient oxygen 
supply; hence the transformations occurring in the viscera 
will not be identical with those when the body lies unburied 
or submerged in water. Vaughan has shown that it is in 
this anaerobic decomposition that ptomains simulating the 
vegetable poisons are likely to be formed. In a recent 
trial it was claimed by Vaughan and others that an organic 
product of animal putrefaction, commonly called indol (but 



PTOMAINS. 649 

properly indin), gives color-reactions simulating some of 
those of morphin. It seems, however, that the probability 
of error from this cause has been overrated, and in general 
it may be said that, with careful routine work, there is no 
great danger of ptomains being mistaken for the well-known 
alkaloid poisons. Much more extended investigation will 
be needed to give precision in this field. 



56 



INDEX. 



ABDOMEN, wounds of, 112 
Abortion, criminal, 202 
feigned, 214 
means employed, 211 
proofs of, 203 
Abortives, 212 
Abstinence from food, 176 
Acetanilid, 634 
Acetate of lead, 485 
Acid, acetic, 513 

arsenic, 459 

arsenous, 435 

boric, 513 

carbolic, 516 

hydrochloric, 409 

hydrocyanic, 619 

meconic, 548 

nitric, 405 

oxalic, 507 

prussic, 619 

sulphuric, 401 

tartaric, 513 
Aconite, 613 
Aconitin, 615 
Aconitum napellus, 613 
Adipocere, 37 
Age deduced from teeth, ^2 

of fetus, 208 

of new-born children, 211 

of skeletons, tj 
Alcohol, 554 

methyl, 558 
Alkalies, poisoning by, 411 
Alum, poisoning by, 418 
Ammonia, poisoning by, 412 
Anesthesia and rape, 282 
Anilin, 633 

colors. 633 
Animal food, noxious, 536 

irritants, 536 
Antagonism of poisons, 378 
Antifebrin, 633 
Antimony, 461 



Antipyrin, (i2>2 

Apparent death, 76 

Aqua-fortis, 405 

Arsenic, 435 

Arseniuretted hydrogen, 460 

Artificial inflation of lungs, 228 

Asphyxia, 137 

Atropa belladonna, 592 

Atropin, 592 



BALLOTTEMENT, 197 
Balls, apertures made by, loi 
Barium, salts of, 420 
Bean, calabar, 617 
Belladonna, 591 
Betanaphthol, 522 
Bettendorf's test, 453 
Bichlorid of mercury, 472 
Binoxalate of potassium, 513 
Birth, premature, 202 

proofs of a live, 217 
Bismuth, poisoning by, 504 
Bitter almonds, oil of, 629 
Bittersweet, 591 
Black drop, 544 

hellebore, 530 
Blisters from burns and scalds, 132 
Blood, corpuscles of, 121 

crystals, 120 

action of poisons on, 385 

serum test for, 120 

stains, detection of, 114 
Blue vitriol, 494 
Body, pallor of, 19 
Bones, age of, 74 

human and animal, 70 

identification of, 70 
Borax, 513 
Boric acid, 513 
Born alive, meaning of, 217 
Brain, injuries of, 108 
Breasts, in pregnancy, 195 



651 



652 



INDEX. 



Bromin, 433 

Brucin, 590 

Buoyancy of the body, 164 

Burns and scalds, death from, 131 

Butter of antimony, 470 



CADAVERIC alkaloids, 645 
lividity, 26 
rigidity, 22 
spasms, 25 
Calabar bean, 617 
Caloricity, post-mortem, 21 
Camphor, 536 

Cantharides, poisoning by, 536 
Capacity, testamentary, 337 
Carbolic acid, poisoning by, 516 
Carbon dioxid, 644 

monoxid, 142, 644 
Castor beans, 525 
Certificates of insanity, 334 
Cheese, poisoning by, 539 
Chenopodium, 529 
Cherry-laurel water, 591 
Chest, wounds of, 112 
Chloral hydrate, 566 
Chlorin, 434 

oxids, 434 
Chloroform, 563 
Chromate of lead, 492 
Chrome yellow, 492 
Chromium, poisoning by, 506 
Clothing, examination of, 94 

stabs in, 94 

stains of, 45 
Coal-tar synthetics, 633 
Cocain, 601 
Cocculus indicus, 642 
Colchicum, poisoning by, 525 
Cold, death from, 171 
Coldness of the body in death, 21 
Colic, painters', 487 
Colica pictonum, 487 
Colostrum, 233 
Coma, death by, 13 
Combustion, spontaneous, 136 
Compression of brain, 109 
Concealment of birth, 253 

of delivery, 253 

of habits in life insurance, 
363 

of pregnancy, 192 



Conception, date of, 257 
Concussion of brain, 108 

of spinal marrow, m 
Confessions in drunkenness, 314 
Conin, 609 

Conium maculatum, 609 
Contusions on living and dead, 87 
Convallaria majalis, 535 
Cooling of body after death, 21 
Copper arsenite, 459 

poisoning by, 493 
Copperas, poisoning by, 506 
Cord, i-iarK of, in banging, 153 

in strangulation, 147 
Coroner, 2 

Coroner's inquests, 2 
Corpus luteum, 198 
Cotton fiber, 83 
Corrosive sublimate, 472 
Courtesy, tenancy by, 263 
Cranium, fractures of, 108 
Cretinism, 308 
Criminal abortion, 202 

court, 4 

responsibility, 340 
Croton oil, poisoning by, 523 

tiglium, 523 
Crying, evidence from, 263 
Crypsorchides, 2y2 
Cyanid of potassium, 628 
Cytisin, 643 
Cytisus laburnum, 643 



DATE of -conception, 257 
Datura stramonium, 597 
Dead body, examination of, 43 

wounds and contusions, 84 
Deadly nightshade, 591 
Death, phenomena and signs of, 12 

presumption of, 55 

violent, causes of, 84 
Deformities, evidence from, 78 
Delirium tremens, 316 
Delivery, concealed, 253 

feigned, 254 

signs of, 253 

unconscious, 253 
Delusions, 298 
Dementia, 323 

prsecox, 324 
Diffusion of poisons, 371 



INDEX. 



653 



Digitalin, 639 

Digitalis, 638 

Dipsomania, 314 

Divorce, legal grounds for, 274 

Doubtful sex, 278 

Drowned, restoration of the, 167 

Drowning, death from, 157 

signs of, 160 
Drunkenness, responsibility of, 315 
Dying declarations, 20 



Gelsemium sempervirens, 532 
Gestation, legal decisions, 251 

normal period, 258 

premature, 258 

protracted, 258 
Gonorrhea in rape, 280 
Green hellebore, 530 
Guaiacum test for blood, 117 
Gunpowder, wounds from, 104 
Gunshot wounds, loi 



ECBOLICS, 212 
Elateriuni, 524 
Electricity, death from, 168 
Emetic, tartar, 461 
Epilepsy. 327 

feigned, 185 
Epsom salt, 503 
Ergot, 212 
Eserin, 618 

Essence of mirbane, 630 
Essential oil of almonds, 591 
Ether, 562 
Eucain, 602 



FACE, wounds of, iii 
Farina in child's stomach, 233 
Fasting, continued, 176 
Feigned abortion, 214 

delivery, 253 

diseases, 179 

insanity, 344 
Fetal circulation, 229 

vessels, changes at birth, 229 
Feticide, 202 
Fetus, character of, 208 
Florence's test, 290 
Food, poisonous, 536 
Formaldehyde, 560 
Fowler's solution, 458 
Foxglove, 638 
Fractures, identity from, 78 

in new-born children, 238 
Freezing, death from, 171 
Fungi, poisonous, 534 



GASOLIN poisoning, 522 
Gelsemic acid, 533 
Gelsemin, 533 



HAIR, identification of, 81 
dyes, 83 
Hallucinations, 298 
Hanging, death by, 151 
Headache powders, 63s 
Head, wounds of, 108 
Heart, wounds of, 112 
Heat a cause of death, 171 
Hellebore, poisoning by, 530 
Hemin crystals, 120 
Hemlock, 6og 
Hemoglobin, 115 
Hemp fiber, 83 
Henbane, 597 
Hermaphroditism, 270 
Holly, 643 

Homicidal mania, 316 
Human bones, 70 
Hydatids, uterine, 203 
Hydrate of chloral, 566 
Hydrochloric acid, 409 
Hydrocyanic acid, 619 
Hydrogen cyanid, 619 
Hydrostatic test, 223 
Hymen, evidence from, 286 
Hyoscyamus, 597 



IDENTITY of the dead, 68 
A of the living, 62 

personal, 61 
Idiocy, 3007 
Illusions, 297 
Imbecility, 309 
Impotence, 271 

Impregnation, unconscious, 200 
Incised wounds, 92 
Indian tobacco, 608 
Infanticide, 216 

proofs of live birth in, 217 



654 



INDEX. 



Infantile leucorrhea, 280 
Inflation of lungs, 225 
Inheritance, 256 
Inquests, coroner's, 2 
Insanity, 314 

feigned, 314 

post-mortem signs of, 330 
Insurance, life, 361 
Intemperance and life insurance, 

364 
Interments, premature, 16 
Intestines, wounds of, 113 
Intoxication and concussion, no 
lodin, 431 
Iron, salts of, 506 
Isolation, 172 

JAMESTOWN weed, 597 
<J Jasmine, yellow, 532 
Jury, coroner's, 2 

grand and petty, 4 

of matrons, 192 

KEROSENE poisoning, 522 
Kleptomania, 314 

LABOR, premature, 202 
Laburnum, 643 
Laudanum, 543 
Lead, 483 
Legitimacy, 256 

laws concerning, 265 
Leucorrhea, infantile, 280 
Levant nut, 642 
Life insurance, 361 
Lightning, death from, 168 
Lily of the Valley, 535 
Linea albicantes, 251 
Linen fibre, 83 
Live birth, 235 
Lividity, cadaveric, 26 
Lobelia inflata, 608 
Lobelin, 609 
Lochia, 252 
Lucid interval, 305 
Lungs, in new-born children, 221 
Lysol, 519 

MAGNESIUM sulphate, 503 
Majority and minority, 266 
Malpractice, 350 



Mania, 311 

feigned, 347 

homicidal, 316 

moral, 312 

suicidal, 317 
Marsh's test, 446 
Maternity, early, 199 
Matrons, jury of, 192 
Meat, poisoned, 541 
Meconic acid, 548 
Meconium, 233 
Melancholia, 310 
Membrana pupillaris, 209 
Menstrual blood, 193 
Menstruation, 193 
Mercury, 471 
Methyl alcohol, 558 

bromid, 567 
Milk, detection of, in stomach, 233 
Mineral acids, poisoning by, 399 
Mirbane, essence of, 630 
Miscarriage, 202 
Monkshood, 613 
Monomania, 311 

homicidal, 316 

suicidal, 317 
Monsters, 264 
Moral insanity, 312 
Morning sickness, 193 
Morphine, 548 
Muriatic acid, 409 
Muscular irritability after death, 21 
Mushrooms, poisonous, 534 
Mydriatics, 591 

NAPHTHALENE, 522 
Naphthol, 522 
Neurotic poisons, 542 
Nicotin, 605 
Nightshade, 591, 599 
Niter, death from, 416 
Nitric acid, 405 
Nitrobenzene, 630 
Nux vomica, 568 



OIL of bitter almonds, 629 
of mirbane, 630 
of savin, 528 
of vitriol, 401 
Oleander poisoning, 528 



INDEX. 



655 



Opium, poisoning by, 543 
Ordeal bean, 617 
Orpiment, 460 
Osmosis of poisons, 387 
Oxalic acid, 507 



PAINTERS' colic, 487 
Palsy from lead, 487 
Paralysis, feigned, 187 

of insane, 321 
Paranoid, 311 
Parental likeness, 267 
Paris green, 459 
Paternity, 267 
Pederastia, 292 

Perforation of stomach, 385. 400 
Personal identity, 61 
Phenol, 516 

Phosphorus, poisoning by, 421 
Physostigmin, 618 
Picrotoxin. 642 
Poisonous food, 536 

gases, 643 
Poisons, absorption of, 370 

antagonism of, 378 

definition of, 369^-*^-^ 

elimination of, 372 

mode of action of, 370 

of death by, Z7^ 

post-mortem imbibition of, 387 
Policy, life insurance, 361 
Post-mortem examination, 43 
Potassium chlorate. 417 

cyanid, 628 

hydroxid, 411 

nitrate, 416 
Pregnancy, 192 

concealed, 192 

in the dead, 201 

precocious, 199 

signs of, 192 

unconscious, 200 
Premature labor, 202 
Presumption of death, 55 

of survivorship, 56 
Pretended fasting, 176 
Privet, 643 

Procreative power, 272 
Protracted gestation, 257 
Prussic acid. 619 
Ptomains, 645 



Ptyalism, mercurial, 474 
Puberty, 272 
Puerperal mania, 325 
Punctured wounds, 91 
Putrefaction, 29 

evidences of, 32 

order of, 34 
Pyromania, 314 



QUICKENING, 195 



282 



RAPE, 275 
anesthesia and 
on adults, 281 
on children, 277 
on the dead, 291 

Realgar, 460 

Reinsch's test, 450 

Resorcinol, 519 

Rigidity, cadaveric, 22 

Rigor mortis, 22 



SALIVATION, mercurial, 474 
Salt of lemons, 513 
of sorrel, 513 
Salicylates, poisoning by. 521 
Sausage poison, 538 
Savin, oil of, 527 
Scalds and burns, 131 
Scheele's green, 459 

prussic acid, 620 
Schweinfurt green, 459 
Semen, test for, 290 
Seminal stains, 288 
Sex. concealed, 270 

doubtful, 270 
Sexual malformation, 270 
Shell-fish, 538, 541 
Shot, wounds made by, loi 
Silk fiber, 83 
Skeletons, age of, 72 

date of interment of, 80 

sex of, 76 

stature of, 76 
Skull, evidences from, 71 
Sleep, pregnancy during, 200 
Smothering, death by, 137 
Sodium fluorid hydroxid, 411 

salicylate, 521 



656 



INDEX. 



Sodomy, 292 
Solanum, 599 
Somatic death, 12 
Somnambulism, 326 
Sorrel, salt of, 513 
Specific gravity of lungs, 223 
Spermatic stains, 288 
Spermatozoids, 289 
Spontaneous combustion, 136 
Starvation, death by, 176 
Static test, 222 
Sterility, 271 
Still births, 218 
Stramonium, 597 
Strangulation, 145 

by umbilical cord, 246 
Strychnin, 569 
Sublimate, corrosive, 472 
Subnitrate of bismuth, 518 
Suffocation, death by, 137 

of new-born children, 243 

signs of, 138 • 
Sugar of lead, 485 
Suggillation, 26 
Suicidal mania, 317 

and life insurance, 365 

wounds, 96 
Sulphuric acid, 401 
Sunstroke, i ^2 
Superfetation, 268 
Survivorship, 55 
Syncope a cause of death, 13 



TARTAR emetic, 461 
Tartaric acid, 513 
Teeth a test of age, T2 

identity from, 66 
Tenancy by courtesy, 263 
Testamentary capacity, 337 
Tetanus from wounds, 106 
Tin, poisoning by salt of, 506 
Tobacco, 603 
Toxicology, 369 
Trional, 634 
Tyrotoxicon, 539 



UMBILICAL cord, in dead born 
and live born children, 231 
Unconscious delivery, 252 
intercourse, 200 
pregnancy, 200 

VAGINA, in rape of children, 278 
-Vaginitis in children, 279 
Veratrin, poisoning by, 531 
Vertebrae, fractures of, iii, 
Viability of the child, 262 
Violation, 275 
Virginity, signs of, 287 
Volition, loss of, by anesthesia, 282 
Vulval penetration, 278 

WADDING, wounds by, 104 
Water-gas poisoning, 644 
Water hemlock, 609 
Weapons, examination of, 90 

of lungs at birth, 222 
White hellebore, 530 

vitriol, 500 
Wills, capacity for making, ZZI 
Witnesses, expert, 6 
Wood spirit, 558 
Wolfsbane, 613 
Wool fiber, 83 

Wormseed oil poisoning, 529 
Wounds, cause of death by, 84 

from gunpowder, 104 

made before and after death, 

87 
on new-born children, 234 
self-inflicted, 190 
upon the burned, 135 



YEL] 



ELLOW arsenic, 460 
jasmine, 532 
Yew, 643 



ZINC, chlorid, 501 
sulphate, 50Q 



im 23 1906 



^ 



